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After a heart attack, also known as myocardial infarction, patients are prescribed several medications to prevent subsequent adverse cardiovascular events. These include a blood-thinning drug to stop blood platelets from sticking together, a lipid-reducing drug, and a blood pressure-lowering drug. Yet more than half of patients fail to consistently take these medications as prescribed. The SECURE study therefore investigated whether a polypill combining three key heart drugs could improve adherence to treatment, thereby better preventing recurrence of cardiovascular events.

The study included 2,499 patients who had suffered a heart attack within the last six months. The research team randomly assigned the patients to the polypill group or the usual-care group (three-pill regimen). The polypill contained acetylsalicylic acid to prevent the formation of blood clots, the ACE inhibitor ramipril to lower blood pressure, and atorvastatin to lower cholesterol in the blood. Usual care was at the discretion of the treating physician. The average age of participants was 76 years, and one-third were women.

Fewer fatal cardiovascular events

After three years, significantly fewer patients in the polypill group had suffered death from cardiovascular causes or new major adverse cardiovascular events like heart attacks or strokes. The researchers found 48 cardiovascular-related deaths in the polypill group and 71 in the control group.

The research team believes the polypill could become an integral element of strategies to prevent recurrent cardiovascular events in patients who have had a heart attack.

“Although most patients initially adhere to treatment after an acute event such as an infarction, adherence drops off after the first few months,” explains study leader Prof. Valentín Fuster, general director of the Spanish National Center for Cardiovascular Research (CNIC) in Madrid, and director of Mount Sinai Heart and physician-in-chief of The Mount Sinai Hospital in New York City. “Our goal was to have an impact right from the start, and most of the patients in the study began taking a simple polypill in the first week after having a heart attack.”

Prof. Wolfram Döhner of the Berlin Institute of Health at Charité (BIH), principle investigator of the German arm of the SECURE study, is convinced by the findings: “The simplified therapy with fewer pills improves patient treatment significantly. This creates a win-win-win situation for patients, physicians, and the healthcare system overall: the polypill works better, is easier to take, and reduces the follow-up costs for recurrent cardiovascular events.”

The SECURE study is a randomized clinical trial in seven European countries, including in Germany under the leadership of Charité – Universitätsmedizin Berlin, and is funded by the European Union.


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

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