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.
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%
- Age ≥65 years
- Prior myocardial infarction
- At least one of the following: diabetes mellitus, chronic kidney disease, coronary revascularization, stroke, age ≥75 years
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.
- 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.
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
< Back to Listings