Polypill Strategy in Secondary Cardiovascular Prevention

This phase 3 randomized controlled trial (SECURE) evaluated the efficacy of a cardiovascular polypill containing aspirin (100 mg), ramipril (2.5–10 mg), and atorvastatin (20 or 40 mg) as a strategy for secondary prevention in patients with a recent myocardial infarction. A total of 2499 patients were randomized to either polypill-based treatment or usual care across seven European countries. Over a median follow-up of 3 years, the primary composite outcome (cardiovascular death, nonfatal myocardial infarction, nonfatal ischemic stroke, or urgent revascularization) occurred in 9.5% of the polypill group vs. 12.7% in the usual-care group (HR: 0.76; 95% CI: 0.60–0.96; P=0.02). The key secondary outcome (excluding revascularization) also favored the polypill (8.2% vs. 11.7%; HR: 0.70; P=0.005). Medication adherence was significantly higher in the polypill group at 6 and 24 months. Blood pressure and LDL cholesterol levels were comparable between groups, while cardiovascular deaths were lower in the polypill arm. Adverse event rates were similar, though noncardiovascular deaths (notably cancer-related) were slightly higher in the polypill group. The trial supports the polypill approach as an effective and adherence-enhancing strategy for secondary prevention in older adults post–myocardial infarction.

This phase 3 randomized controlled trial (SECURE) evaluated the efficacy of a cardiovascular polypill containing aspirin (100 mg), ramipril (2.5–10 mg), and atorvastatin (20 or 40 mg) as a strategy for secondary prevention in patients with a recent myocardial infarction. A total of 2499 patients were randomized to either polypill-based treatment or usual care across seven European countries. Over a median follow-up of 3 years, the primary composite outcome (cardiovascular death, nonfatal myocardial infarction, nonfatal ischemic stroke, or urgent revascularization) occurred in 9.5% of the polypill group vs. 12.7% in the usual-care group (HR: 0.76; 95% CI: 0.60–0.96; P=0.02). The key secondary outcome (excluding revascularization) also favored the polypill (8.2% vs. 11.7%; HR: 0.70; P=0.005). Medication adherence was significantly higher in the polypill group at 6 and 24 months. Blood pressure and LDL cholesterol levels were comparable between groups, while cardiovascular deaths were lower in the polypill arm. Adverse event rates were similar, though noncardiovascular deaths (notably cancer-related) were slightly higher in the polypill group. The trial supports the polypill approach as an effective and adherence-enhancing strategy for secondary prevention in older adults post–myocardial infarction.