Polypill 'could become a reality'
A cheap five-in-one pill can guard against heart attacks and stroke, research suggests.
The concept of a polypill for everyone over 55 to cut heart disease by up to 80% was mooted over five years ago, but slow progress has been made since.
Now a trial in India shows such a pill has the desired effects and is safe and well-tolerated by those who take it.
Although The Lancet study is proof of concept, experts still question the ethics of a pill for lifestyle issues.
Critics say the problems of high blood pressure and cholesterol should be tackled with diet and exercise rather than by popping a pill.
The polypill used in the latest study combines five active pharmacological ingredients widely available separately - aspirin, a statin to lower cholesterol and three blood pressure-lowering drugs - as well as folic acid.
Does what it says on the tin
Trials on 2,053 healthy individuals free of cardiovascular disease, but with a risk factor such as high blood pressure or a long-term smoker, showed combining the drugs into one tablet delivered a similar effect to each drug separately.
Reductions were seen in both blood pressure and cholesterol without any major side effects.
The researchers believe that the combined action of all the components in their "Polycap" capsule made by Cadila Pharmaceuticals, could potentially halve strokes and heart attacks in average, middle-aged people.
On a global scale, this would save tens of millions of lives.
The study, led by Dr Salim Yusuf, from McMaster University in Ontario, Canada, took in people at 50 centres across India.
A spokeswoman for the British Heart Foundation said: "The results suggest that the polypill has the potential to reduce the incidence of cardiovascular disease.
"We now need further research to examine whether the polypill actually reduces mortality."
A UK team led by Professor Simon Thom of Imperial College London is hoping to do just this.
They have been testing a four-in-one polypill called the Red Heart Pill, with the backing of the Wellcome Trust and the British Heart Foundation, which could cost as little as 15 euros per person per year.
Professor Thom said it would be at least five years before there was enough data to convince drug regulators to approve a polypill.
"Mounting evidence shows the polypill does exactly what it should, but no more, whereas exercise has wide reaching effects on health and wellbeing. So a polypill is an addition rather than a replacement for lifestyle interventions."
Mike Rich of UK charity the Blood Pressure Association said: "This study further stimulates the debate over whether a 'magic bullet' is the answer to the prevention of heart disease and strokes.
"Eating healthily and taking regular exercise are proven ways to lower high blood pressure - and have many other health benefits too - and there is a danger that these lifestyle factors could be overlooked in favour of 'popping a pill'."
Joanne Murphy of The Stroke Association said: "By combining these medications in one pill, it will make it easier for people to take their medication. However, it is important that more research and investigation is done into this pill to ensure its safety."
One GP, Dr Sarah Jarvis, said the pill should not be viewed as an alternative to improving lifestyles through diet and exercise.
"What we need to bear in mind is that this may well cut the likelihood of dying of heart disease dramatically. Fantastic. But it's not going to stop you getting arthritis, it's not going to stop you get lung disease," she said.