6/29/23, 11:41 PM SECURE Pathway Feedback Search Clinical Topics Home Studies SECURE SECURE Disease Disease Disease Coronary artery disease Non-ST-elevation myocardial inf ST-elevat Trial question What is the role of cardiovascular polypill strategy in the secondary prevention of CVD? Study design Multi-center Open label RCT Population Characteristics of study participants 31.0% female N = 2466 69.0% male 2466 patients (765 female, 1701 male) Inclusion criteria: elderly patients with myocardial infarction within the previous 6 months Key exclusion criteria: receipt of oral anticoagulation; severe congestive HF; severe renal disease; severe liver impairment; significant arrhythmias Interventions N=1237 polypill strategy (a single pill containing aspirin 100 mg, ramipril 2.5, 5, or 10 mg, and atorvastatin 40 mg) N=1229 usual care (standard of care therapies according to the ESC) Primary outcome https://web.pathway.md/studies/recOyXHbShw5uMbPC 1/2 6/29/23, 11:41 PM SECURE Pathway Composite outcome of cardiovascular death, nonfatal type 1 myocardial infarction, nonfatal ischemic stroke, or urgent revascularization 12.7 % 12.7 9.5 % 9.5 6.3 % Significant decrease 3.2 % NNT = 31 0.0 % Polypill strategy Usual care Significant decrease in composite outcome of cardiovascular death, nonfatal type 1 myocardial infarction, nonfatal ischemic stroke, or urgent revascularization (9.5% vs. 12.7%; HR 0.76, 95% CI 0.6 to 0.96) Secondary outcomes Significant decrease in composite outcome of cardiovascular death, nonfatal type 1 myocardial infarction, or nonfatal ischemic stroke (8.2% vs. 11.7%; HR 0.7, 95% CI 0.54 to 0.9) Borderline significant decrease in cardiovascular death (3.9% vs. 5.8%; HR 0.67, 95% CI 0.47 to 0.97) Borderline significant increase in the percentage of patients with high adherence to medication at 2 years (74.1% vs. 63.2%; RR 1.17, 95% CI 1.1 to 1.25) Safety outcomes No significant differences in death from any cause, adverse events, and nonfatal serious adverse events. Conclusion In elderly patients with myocardial infarction within the previous 6 months, polypill strategy was superior to usual care with respect to the composite outcome of cardiovascular death, nonfatal type 1 myocardial infarction, nonfatal ischemic stroke, or urgent revascularization. Reference Jose M Castellano, Stuart J Pocock, Deepak L Bhatt et al. Polypill Strategy in Secondary Cardiovascular Prevention. N Engl J Med. 2022 Sep 15;387(11):967-977. Open reference URL https://web.pathway.md/studies/recOyXHbShw5uMbPC 2/2