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Dyslipidaemia Global Newsletter #3 Dyslipi
Dyslipi
Polypill strategy in secondary cardiovascular prevention. aim ead

Castellano JM, et al. N Engl J Med. 2022; 387:967-77.

Adherence to treatment that provides secondary cardiovascular
prevention has been estimated to be ~50%, and this lack of
adherence has been associated with poorer outcomes. A polypill
(containing aspirin, an ACEi, and a statin) was proposed as
a simple approach to improve adherence and for secondary
prevention of CV death and complication after MI.

The Secondary Prevention of Cardiovascular Disease in the
Elderly Trial (SECURE) was a phase 3, randomized, controlled,
multi-national study, which included 2499 older adults (>75
years of age or =65 years with at least one CV risk factor) with
MI in the previous six months. Patients were assigned to a
polypill strategy (consisting of aspirin 100 mg; ramipril 2.5, 5, or
10 mg; and atorvastatin 20 or 40 mg) or usual care (consisting
of a care program based on current European Society of
Cardiology guidelines).

During a median follow-up of three years, the incidence of the CLINICAL PEARLS FROM THE FACULTY
primary outcome events, which was a composite measure of
CV death, non-fatal MI, non-fatal ischemic stroke, or urgent
coronary revascularization, was significantly lower in the polypill
group compared to the usual-care group. Medication adherence,
as reported by the patients at six and 24 months, was also
higher in the polypill group. The incidence of adverse events,
serious adverse events, and death from any cause were similar
in the two groups.

No substantial differences were found in LDL-C and blood
pressure between the two groups. The lower risk of CV events
in the absence of substantial differences in these measures may
be explained by pleiotropic effects of statins and ACE inhibitors
beyond the effects on LDL-C levels and BP levels, respectively.

The use of a cardiovascular WATCH
polypill in place of several separate PROF. SANDIN DISCUSS THE CLINICAL
cardiovascular drugs could be APPLICATION OF THE SECURE TRIAL
an integral part of an effective TO EVERYDAY PRACTICE.
secondary prevention strategy.
Simplifying the treatment may
improve adherence and reduce
the risk of recurrent disease and
cardiovascular death.

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