Intended for healthcare professionals

Rapid response to:


A cure for cardiovascular disease?

BMJ 2003; 326 doi: (Published 26 June 2003) Cite this as: BMJ 2003;326:1407

Rapid Response:

Re: As much fantasy as a multi-vitamin

Dear Dr. Beeth,

Your suggestion that vitamin B12 should be included in Polypill [tm]
is a good one. Polypill's 0.8 mg folic acid (vitamin B9) is below the
several milligrams needed to mask possibly irreversible B12 deficiency
problems but B12 works with folic acid in homocysteine [Hcy] remethylation
to methionine. I would suggest to also include vitamin B6 that acts to
cover a second Hcy lowering pathway, to cysteine. Moreover, these
additions could be without increased cost and it's illogical to chose one
Hcy lowering pathway over another.

One problem with Polypill is that it has never been tested in a
population with ample omega-3 intake and with Hcy levels below 10
micromol/L, a level attainable in most with a high "potency" multiple B
vitamin supplement.

Let's assume for a moment that mortality and cardiovascular events
can be reduced by 70% with the omega-3 oil alpha-linolenic acid [found,
for example, in flax, canola and walnut oils]. This percentage is in line
with the Wald/Law estimate for Polypill and is not unrealistic according
to Medline PMID 12668490, 12433513 and 9989956.

My guess is that none of the studies in the Wald/Law meta analysis
were adjusted for these apparently enormously efficacious omega-3 oils or
for the family of Hcy lowering nutrients. It would seem to me that
unleashing the Wald/Law methodology on the omega-3 and Hcy lowering
pathways would yield results -not only in the cardio department- that may
well obviate the need for pharma-based polypills with side-effects that
these nutrient approaches clearly don't have. I note that high Hcy status
has now been positively associated with over 100 diseases or conditions
while the statins in Polypill are linked to the same number of harmfull

Competing interests:  
None declared

Competing interests: No competing interests

03 July 2003
Eddie Vos
Sutton Qc J0E 2K0 Canada