Czech footprints in the international study of secondary prevention after myocardial infarction

Clinical trial SECURE (Secondary Prevention of Cardiovascular Disease in the Elderly) tried to investigate whether a fixed combination of common cardiovascular drugs “only” brings easier medication use for the patients or whether it can also bring other clinical benefits.

The study took place between 2016 and 2019. It was an international non-commercial project supported by the EU budget by the Horizon 2020 programme. Eight Czech hospitals participated in the study, namely the General University Hospital in Prague, Na Homolce Hospital, University Hospital Královské Vinohrady, University Hospital Olomouc, Hospital of Rudolf and Stefanie in Benešov, hospitals in Slané, Jihlava, and Třinec-Podlesí. VI CZECRIN provided regular monitoring of the correct course of the study in the Czech Republic.

In Europe, almost 2,500 patients over 65 years who recently suffered a myocardial infarction were included. As secondary prevention of recurrence of ischemic events, the participants were given either an investigational fixed triple combination of ramipril + atorvastatin + acetylsalicylic acid in one capsule or standard pharmacotherapy according to the European guidelines. There were 6 versions of the fixed triple combination according to the doses of the individual drugs so that the treatment could be adjusted individually. Patients were followed for up to 4 years.

In principle, the pharmacotherapy did not differ in the two groups, and both groups achieved approximately the same blood pressure and LDL cholesterol concentration. The adverse effects were also similar in both groups. Patients with the triple combination had better adherence to treatment. Although the difference was not dramatic, about 11% more adherent patients in the fixed triple combination group, it probably contributed to a significant decrease in ischemic events and deaths from cardiovascular causes. The risk of these events was approximately 25% lower compared to the standard treatment group.

Thanks not only to Czech investigators and participants, healthcare professionals now have proof that simplifying chronic medication can lead to significant clinical benefits.

Link to study results: https://www.nejm.org/doi/10.1056/NEJMoa2208275

We thank all current and former colleagues who participated in the study as part of RI CZECRIN!