Polypill Strategy in Secondary Cardiovascular Prevention

To the Editor: In their article on the Secondary Prevention of Cardiovascular Disease in the Elderly (SECURE) trial, Castellano et al. (Sept. 15 issue)(1) report that treatment with a polypill containing aspirin, ramipril, and atorvastatin was associated with a significantly lower risk of cardiovascular events than usual care in older patients with recent myocardial infarction. However, this polypill did not contain a beta-blocker, although it is has been known for decades that these drugs are particularly effective after myocardial infarction(2,3) and their use is recommended in current guidelines.(4,5) Therefore, can the SECURE investigators report data to answer the question of . . .

Automated summary

In the SECURE trial, it was found that the use of a polypill containing aspirin, ramipril, and atorvastatin significantly reduced the risk of cardiovascular events in older patients with recent myocardial infarction. However, the absence of beta-blockers in this polypill raised questions as these drugs have been known to be effective after myocardial infarction and are recommended in current guidelines.