New ‘polypill’ combines aspirin and statins to save more people after a heart attack

NEW YORK — A new pill that combines several medications can significantly cut the risk of death after a heart attack, new research reveals. Scientists at The Mount Sinai Hospital say this one “polypill” could replace all the prescription drugs patients normally have to take after a cardiac event.

A team from the Spanish National Center for Cardiovascular Research (CNIC) and pharmaceutical company Ferrer developed the three-drug pill. It combines aspirin, a blood pressure medication, and a statin into one, which researchers say increases the odds that patients won’t forget to take these drugs after a heart attack.

Overall, the SECURE trial found that the polypill reduced heart disease-related deaths among heart attack patients by 33 percent.

“The results of the SECURE study show that for the first time that the polypill, which contains aspirin, ramipril, and atorvastatin, achieves clinically relevant reductions in the recurrent cardiovascular events among people who have recovered from a previous heart attack because of better adherence to this simplified approach with a simple polypill, rather than taking them separately as conventional,” says Valentin Fuster, MD, PhD, Director of Mount Sinai Heart and General Director of CNIC, in a media release.

What’s in the pill?

After a heart attack, doctors prescribe a number of specific treatments to prevent additional heart problems in the future. These prescriptions usually include three drugs: an antiplatelet agent like aspirin, a drug to control blood pressure like ramipril, and a lipid-reducing statin. Unfortunately, study authors say less than 50 percent of patients continue to take all of these drugs after their health scare.

“Although most patients initially adhere to treatment after an acute event such as an infarction, adherence drops off after the first few months. Our goal was to have an impact right from the start, and most of the patients in the study began taking a simple polypill in the first week after having a heart attack,” Dr. Fuster explains.

“Adherence to treatment after an acute myocardial infarction is essential for effective secondary prevention,” adds study first author José María Castellano, MD, Scientific Director of Fundación de Investigación HM Hospitales.

The CNIC team set out to make a drug that could simplify the process for heart attack patients. Ultimately, they created the polypill, which includes aspirin (100 mg), the angiotensin-converting enzyme inhibitor ramipril (2.5, 5, or 10 mg), and atorvastatin (20 or 40 mg). The team has commercialized the drug under the name Trinomia.

“The polypill, being a very simple strategy that combines three essential treatments for this type of patient, has proved its worth because the improved adherence means that these patients are receiving better treatment and therefore have a lower risk of recurrent cardiovascular events,” says Dr. Castellano.

Polypill users less likely to forget their meds

During the SECURE trial, Fuster’s team examined 2,499 patients from seven European countries who were all recovering from a heart attack. The patients either received standard treatment or the polypill. The team notes that the average age of these individuals was 76 and over three-quarters had hypertension. More than half also had diabetes and 51 percent had a history of smoking.

The team kept track of four major cardiovascular events: death from heart-related issues, another non-fatal heart attack, a non-fatal stroke, and a blocked artery requiring revascularization. Over the next three years, the results reveal patients taking the polypill had a 24-percent lower risk of all four events in comparison to people taking these drugs separately.

Researchers say the most important finding is that the polypill cut the risk of death after a heart attack by 33 percent, from 71 patients among the standard treatment group to 48 in the polypill group. The study also found the polypill group was more likely to continue their treatment than those juggling all of these medications separately.

“The SECURE study findings suggest that the polypill could become an integral element of strategies to prevent recurrent cardiovascular events in patients who have had a heart attack. By simplifying treatment and improving adherence, this approach has the potential to reduce the risk of recurrent cardiovascular disease and death on a global scale,” Dr. Fuster concludes.

The findings are published in The New England Journal of Medicine.

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