- Question
- Does a polypill strategy containing aspirin, ramipril and atorvastatin reduce major cardiovascular events in patients with a recent myocardial infarction compared with usual care?
- Design
- Phase 3, randomized, controlled, open-label (unmasked) trial that randomized 2499 patients, with a median follow-up of 36 months.
- Population
- Patients with a myocardial infarction within the previous 6 months (the registry describes it as a secondary prevention trial in older adults).
- Intervention
- A once-daily oral polypill strategy combining aspirin 100 mg, ramipril (2.5, 5 or 10 mg) and atorvastatin (20 or 40 mg).
- Control
- Usual care: guideline-based secondary prevention therapies, with drugs and doses left to the treating physician's discretion.
- Primary outcome
- Composite of cardiovascular death, nonfatal type 1 myocardial infarction, nonfatal ischemic stroke, or urgent revascularization.
- Results
- A primary-outcome event occurred in 118 of 1237 patients (9.5%) in the polypill group and 156 of 1229 (12.7%) in the usual-care group (HR 0.76; 95% CI 0.60 to 0.96; P = 0.02). The key secondary outcome (cardiovascular death, nonfatal type 1 myocardial infarction, or nonfatal ischemic stroke) occurred in 101 patients (8.2%) versus 144 (11.7%) (HR 0.70; 95% CI 0.54 to 0.90; P = 0.005).
- Safety
- Adverse events were similar between groups. Patient-reported medication adherence was higher with the polypill.
- Conclusion
- Treatment with a polypill of aspirin, ramipril and atorvastatin within 6 months after myocardial infarction significantly lowered the risk of major adverse cardiovascular events compared with usual care.
- Why it matters
- The trial supported the idea that consolidating secondary prevention therapy into a single pill can improve adherence and clinical outcomes after myocardial infarction, and strengthened interest in fixed-dose combination strategies.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 14, 2026