A study in NEJM found that heart attack patients who took a “polypill” (a 3-part cocktail of aspirin, ramipril, and atorvastatin) had a lower risk of major CV events. But findings from the SECURE trial also left some docs scratching their heads.
The authors randomized 2.5k patients who had experienced a heart attack within the last six months into a “polypill” group or “usual-care” group. Patients in both groups typically received aspirin, statin, and ACE inhibitor, but the polypill group only took one combo tablet, while the usual-care group took each medication separately.
- Over a three-year follow-up period, patients who took the polypill were 24% less likely to experience cardiovascular death, myocardial infarction, stroke, or urgent revascularization.
- The polypill advantage likely came down to adherence. Patients who received the polypill were more likely to have a high level of adherence at two years (74.1% vs. 63.2%).
The Twist: While the polypill seemed to protect against cardiovascular events, it did not produce meaningful changes in blood pressure or lipid levels.
- The polypill and usual-care groups had nearly identical systolic (135.2 vs. 135.5 mmHg) and diastolic (74.8 vs. 74.9 mmHg) blood pressure at two years.
- LDL-cholesterol levels were also similar (67.7 vs. 67.2 mg/dL).
The authors speculate that greater adherence may have prompted positive effects that simply did not influence lipid and blood pressure measurements.
The study underscores that convenience is often the key to compliance. Treatments won’t work unless they are consistently utilized, and the polypill was the patient-friendly solution some needed to stick to their prescribed regimen.