Secondary Prevention of Cardiovascular Disease in the Elderly - SECURE

Oct 03, 2022
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Author/Summarized by Author:
Anthony A. Bavry, MD,MPH,FACC
Summary Reviewer:
Kim A. Eagle, MD, MACC
Trial Sponsor:
European Union Horizon 2020
Date Presented:
08/26/2022
Date Published:
09/23/2022
Date Updated:
10/03/2022
Original Posted Date:
08/26/2022
References

Contribution To Literature:

Highlighted text has been updated as of October 3, 2022.

The SECURE trial showed that a polypill strategy (aspirin, statin, ACE inhibitor) can prevent adverse cardiovascular events.

Description:

The goal of the trial was to evaluate a polypill strategy compared with usual care among individuals who had a myocardial infarction within the last 6 months.

Study Design

  • Randomization
  • Parallel

Patients with prior myocardial infarction were randomized to a polypill (n = 1,258) versus usual care (n = 1,241). The polypill consisted of aspirin 100 mg, atorvastatin (20 or 40 mg), and ramipril (2.5, 5, or 10 mg).

  • Total number of enrollees: 2,499
  • Duration of follow-up: 3 years
  • Mean patient age: 75.8 years
  • Percentage female: 31%
  • Percentage with diabetes: 42%

Inclusion criteria:

  • Age ≥65 years
  • Prior myocardial infarction
  • At least one of the following: diabetes mellitus, chronic kidney disease, coronary revascularization, stroke, age ≥75 years

Principal Findings:

The primary outcome of cardiovascular death, myocardial infarction, stroke, or urgent revascularization occurred in 9.5% of the polypill group vs. 12.7% of the usual care group (p = 0.02). The results were consistent across subgroups.

Secondary outcomes:

  • Cardiovascular death, myocardial infarction, or stroke: 8.2% of the polypill group vs. 11.7% of the usual care group (p = 0.005)
  • All-cause mortality: 9.3% of the polypill group vs. 9.5% of the usual care group (p = 0.79)
  • Medication adherence was higher in the polypill group vs. usual care group

Interpretation:

Among older individuals with prior myocardial infarction, a polypill strategy was beneficial. A polypill strategy reduced adverse cardiovascular events (cardiovascular death, myocardial infarction, stroke, or urgent revascularization) compared with usual care. All-cause mortality was similar between treatment groups. Increased adherence could partly explain the benefit from this strategy.

References:

Editorial Comment: Liuzzo G, Patrono C. A SECURE Polypill as a Strategy at the Heart of Secondary Prevention. Eur Heart J 2022;Sep 23:[Epub ahead of print].

Castellano JM, Pocock SJ, Bhatt DL, et al., on behalf of the SECURE Investigators. Polypill Strategy in Secondary Cardiovascular Prevention. N Engl J Med 2022;387:967-77.

Editorial: Wang TJ. The Polypill at 20 — What Have We Learned? N Engl J Med 2022;387:1034-6.

Presented by Dr. Valentin Fuster at the European Society of Cardiology Congress (ESC 2022), Barcelona, Spain, August 26, 2022.

Clinical Topics: Acute Coronary Syndromes, Cardiac Surgery, Cardiovascular Care Team, Dyslipidemia, Geriatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Prevention, Cardiac Surgery and Arrhythmias, Lipid Metabolism, Nonstatins, Novel Agents, Statins, Interventions and ACS

Keywords: ESC Congress, ESC22, Acute Coronary Syndrome, Angiotensin-Converting Enzyme Inhibitors, Aspirin, Atorvastatin, Diabetes Mellitus, Geriatrics, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Medication Adherence, Myocardial Infarction, Myocardial Revascularization, Primary Prevention, Ramipril, Renal Insufficiency, Chronic, Secondary Prevention, Stroke


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