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00925njm 22002777a 4500 dc Castellano, Jose Maria author Pocock, Stuart J author Bhatt, Deepak L author Quesada, Antonio J author Owen, Ruth author Fernandez-Ortiz, Antonio author Molina-Sanchez, Pedro author Marin Ortuño, Francisco author Vazquez Rodriguez, Jose M author Domingo-Fernández, Alexandra author Lozano, Iñigo author Roncaglioni, Maria C author Baviera, Marta author Foresta, Andreana author Ojeda-Fernandez, Luisa author Colivicchi, Furio author Di Fusco, Stefania A author Doehner, Wolfram author Meyer, Antje author Schiele, François author Ecarnot, Fiona author Linhart, Aleš author Lubanda, Jean-Claude author Barczi, Gyorgy author Merkely, Bela author Ponikowski, Piotr author Kasprzak, Marta author Fernandez-Alvira, Juan Miguel author Andres, Vicente author Bueno, Hector author Collier, Timothy author Van de Werf, Frans author Perel, Pablo author Rodriguez-Manero, Moises author Alonso Garcia, Angeles author Proietti, Marco author Schoos, Mikkel M author Simon, Tabassome author Fernandez Ferro, Jose author Lopez, Nicolas author Beghi, Ettore author Bejot, Yannick author Vivas, David author Cordero, Alberto author Ibáñez, Borja author Fuster, Valentin author 2022-09-15 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.). N Engl J Med. 2022 Sep 15;387(11):967-977. http://hdl.handle.net/20.500.12105/16468 36018037 10.1056/NEJMoa2208275 1533-4406 The New England journal of medicine Polypill Strategy in Secondary Cardiovascular Prevention.