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One for all - Polypill reduces risk of recurrent heart attack better than single drugs

Europe-wide study shows that a pill containing both the blood thinner ASA and substances that lower blood lipid concentrations and blood pressure is better than three individual tablets. | © ljubaphoto/iStock

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A pill containing aspirin and medications to lower lipids and blood pressure more effectively prevents further adverse cardiovascular events after a heart attack compared with taking the drugs separately. That's the finding of the Europe-wide SECURE study, which has now been presented at the ESC Congress 2022 in Barcelona and published simultaneously in the medical journal "New England Journal of Medicine". The German arm of the study was led by DZHK scientist Wolfram Döhner from Charité - Universitätsmedizin Berlin.

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After a myocardial infarction, patients are prescribed medications to prevent subsequent cardiovascular events. These include an antiplatelet, lipid lowering medication, and a blood pressure lowering and vascular stabilising drug. However, less than 50% of post-infarction patients consistently take all of their medications. It has been proposed that a polypill containing all three treatments would make it easier for patients to adhere to their medication.

Patients who had previously suffered a heart attack within six months took part in the study. 2,499 post-infarction patients were randomly allocated to the polypill group or to the usual care with three individual tablets. The polypill contained acetylsalicylic acid (ASA, Aspirin) to thin the blood, the ACE inhibitor ramipril, and atorvastatin to lower blood cholesterol. Usual treatment was at the discretion of the treating physician. The average age of the participants was 76 years, and one-third were women.

Fewer fatal cardiovascular events

After three years, significantly fewer participants in the polypill group had suffered new dangerous or fatal cardiovascular events such as heart attack or stroke. Thus, 48 patients in the polypill group had died due to cardiovascular events, compared with 71 in the control group.

From the study team's perspective, the polypill could become an integral part of strategies to prevent cardiovascular events in post-infarction patients.

Study leader Dr. Valentin Fuster of the Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain and Mount Sinai Health System, New York, US said: “The results of SECURE show, for the first time, that a polypill containing aspirin, atorvastatin, and ramipril leads to clinically relevant reductions in recurrent cardiovascular events in post-myocardial infarction patients.”

Professor Wolfram Döhner from the Berlin Institute of Health at Charité (BIH), national principal investigator of the SECURE study for Germany, is convinced by the results: "The simplified therapy with fewer tablets significantly improves patient treatment: This gives us a win-win-win situation for patients, physicians and the healthcare system: The polypill works better, is easier to take and reduces the follow-up costs for recurrent cardiovascular events."

The SECURE study is a pan-European study involving a total of seven countries, including Germany led by Charité-Universitätsmedizin Berlin, funded by the European Union.

Polypill Strategy in Secondary Cardiovascular Prevention. NEJM, August 26, 2022 DOI: 10.1056/NEJMoa2208275

Source: Press release of the European Society of Cardiology