{"id":"d8d3ae5374f4","type":"article","url":"https://hartvaat.nl/2022/09/15/polypill-voor-secundaire-cardiovasculaire-preventie-secure-trial-in-nejm/","title":"Polypill voor secundaire cardiovasculaire preventie: SECURE-trial in NEJM","title_en":"Polypill Strategy in Secondary Cardiovascular Prevention.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["aspirine","figaro-dkd","kanker-en-hart","ramipril","rosuvastatine"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2208275","source_url":"https://doi.org/10.1056/NEJMoa2208275","authors":["Jose M Castellano","Stuart J Pocock","Deepak L Bhatt","Antonio J Quesada","Ruth Owen","Antonio Fernandez-Ortiz","Pedro L Sanchez","Francisco Marin Ortuño","Jose M Vazquez Rodriguez","Alexandra Domingo-Fernández","Iñigo Lozano","Maria C Roncaglioni","Marta Baviera","Andreana Foresta","Luisa Ojeda-Fernandez","Furio Colivicchi","Stefania A Di Fusco","Wolfram Doehner","Antje Meyer","François Schiele","Fiona Ecarnot","Aleš Linhart","Jean-Claude Lubanda","Gyorgy Barczi","Bela Merkely","Piotr Ponikowski","Marta Kasprzak","Juan M Fernandez Alvira","Vicente Andres","Hector Bueno","Timothy Collier","Frans Van de Werf","Pablo Perel","Moises Rodriguez-Manero","Angeles Alonso Garcia","Marco Proietti","Mikkel M Schoos","Tabassome Simon","Jose Fernandez Ferro","Nicolas Lopez","Ettore Beghi","Yannick Bejot","David Vivas","Alberto Cordero","Borja Ibañez","Valentin Fuster"],"significance":10,"published":"2022-09-15","source_date":"2022-09-15","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/polypil-cardiovasculair/","https://hartvaat.nl/kennis/lipiden/ezetimib/"],"congress":"","summary_en":"The SECURE trial demonstrated that a cardiovascular polypill containing aspirin, ramipril, and atorvastatin reduced major adverse cardiovascular events by 24% compared with separate medications in patients after myocardial infarction. The benefit was attributed to improved adherence, validating the polypill as a practical secondary prevention strategy.","created":"2026-07-03T10:29:56Z","updated":"2026-07-03T13:29:02Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De SECURE-trial in de NEJM toonde dat een polypil (aspirine, ramipril, atorvastatine) het risico op cardiovasculaire events met 24% verminderde vergeleken met afzonderlijke medicatie na myocardinfarct. De polypil verbeterde de therapietrouw en is een eenvoudige, effectieve strategie voor secundaire preventie.","abstract_original":"BACKGROUND: A polypill that includes key medications associated with improved outcomes (aspirin, angiotensin-converting-enzyme [ACE] inhibitor, and statin) has been proposed as a simple approach to the secondary prevention of cardiovascular death and complications after myocardial infarction. METHODS: In this phase 3, randomized, controlled clinical trial, we assigned patients with myocardial infarction within the previous 6 months to a polypill-based strategy or usual care. The polypill treatment consisted of aspirin (100 mg), ramipril (2.5, 5, or 10 mg), and atorvastatin (20 or 40 mg). The primary composite outcome was cardiovascular death, nonfatal type 1 myocardial infarction, nonfatal ischemic stroke, or urgent revascularization. The key secondary end point was a composite of cardiovascular death, nonfatal type 1 myocardial infarction, or nonfatal ischemic stroke. RESULTS: A total of 2499 patients underwent randomization and were followed for a median of 36 months. A primary-outcome event occurred in 118 of 1237 patients (9.5%) in the polypill group and in 156 of 1229 (12.7%) in the usual-care group (hazard ratio, 0.76; 95% confidence interval [CI], 0.60 to 0.96; P = 0.02). A key secondary-outcome event occurred in 101 patients (8.2%) in the polypill group and in 144 (11.7%) in the usual-care group (hazard ratio, 0.70; 95% CI, 0.54 to 0.90; P = 0.005). The results were consistent across prespecified subgroups. Medication adherence as reported by the patients was higher in the polypill group than in the usual-care group. Adverse events were similar between groups. CONCLUSIONS: Treatment with a polypill containing aspirin, ramipril, and atorvastatin within 6 months after myocardial infarction resulted in a significantly lower risk of major adverse cardiovascular events than usual care. (Funded by the European Union Horizon 2020; SECURE ClinicalTrials.gov number, NCT02596126; EudraCT number, 2015-002868-17.)."}