Secondary Prevention of Cardiovascular Disease in the Elderly - SECURE

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.


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


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.


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, 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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