{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T18:00:13Z","timestamp":1784138413088,"version":"3.55.0"},"reference-count":42,"publisher":"Ubiquity Press, Ltd.","issue":"1","license":[{"start":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T00:00:00Z","timestamp":1758672000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["gh"],"abstract":"<jats:p>Background: The SECURE trial demonstrated that the cardiovascular (CV)-polypill (acetylsalicylic acid [ASA] + atorvastatin + ramipril) reduces CV mortality by 33% in patients with acute myocardial infarction compared to standard care. The 2023 ACS ESC Guidelines recommend the polypill to improve outcomes and adherence.\nObjective: This study aims to establish a global consensus on the optimal use of the CV-polypill in secondary prevention.\nMethods: A two-round, modified Delphi method was used, featuring a 30-statement evidence-based questionnaire validated by eight renowned cardiologists. Fifty clinicians from 19 countries in Europe, Latin America, and Asia were invited to join the Delphi panel. Panelists ranked responses using a three-point Likert scale for agreement and importance. Consensus was defined as \u226580% agreement or rating statements \u2018very important\u2019 or \u2018important\u2019. Statements without consensus after the first round were refined with evidence and feedback in the second round. Remaining disagreements were resolved in a face-to-face meeting. Descriptive statistics were applied.\nResults: Response rate was 76% (round 1) and 74% (round 2); 82% were cardiologists, with 74% frequently recommending the CV-polypill. Consensus was achieved on 93.3% of statements. Research showing a 24% relative risk reduction in major adverse CV events over a median of 3 years with the CV-polypill post-acute myocardial infarction, compared to usual care, reached 97.4% agreement for clinical implementation, and a 100% consensus supported polypill use at hospital discharge or first follow-up visits; 81.1% agreed on a prompt initiation after patient stabilization. There was agreement on algorithms for initiating (97.3%), considering patient preferences (97.4%) to the polypill and its cost savings over usual care (89.5%).\nConclusion: The Delphi consensus on real-world use of a CV polypill (ASA, atorvastatin, and ramipril) for secondary prevention post-acute coronary syndrome supports early initiation (within 8 days or at discharge). The findings provide a foundation to inform practice and policy, identifying priorities for further research.<\/jats:p>","DOI":"10.5334\/gh.1466","type":"journal-article","created":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T09:29:14Z","timestamp":1758706154000},"page":"83","source":"Crossref","is-referenced-by-count":4,"title":["The Polypill (Acetyl Salicylic Acid, Atorvastatin, and Ramipril) Paradigm Shift in Secondary Prevention: Global Expert Delphi Consensus"],"prefix":"10.5334","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7324-8993","authenticated-orcid":false,"given":"Daniel","family":"Pi\u00f1eiro","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9681-3388","authenticated-orcid":false,"given":"Jos\u00e9 Ram\u00f3n","family":"Gonz\u00e1lez-Juanatey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0786-7830","authenticated-orcid":false,"given":"Ana","family":"Abreu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6923-1232","authenticated-orcid":false,"given":"Enrique G\u00f3mez","family":"Alvarez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4864-1088","authenticated-orcid":false,"given":"Carlos","family":"Ponte-Negretti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0758-9685","authenticated-orcid":false,"given":"Burkhard","family":"Weisser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3563-9627","authenticated-orcid":false,"given":"Alexander","family":"Parkhomenko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6224-4866","authenticated-orcid":false,"given":"Francisco","family":"Ara\u00fajo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2195-5020","authenticated-orcid":false,"given":"Alvaro","family":"Sosa-Liprandi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3285","published-online":{"date-parts":[[2025,9,24]]},"reference":[{"key":"key20250924092908_B1","unstructured":"WHO. Cardiovascular diseases (CVDs). Fact sheets [Internet]. 2021 [cited 2023 Jun 27]. Available from: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/cardiovascular-diseases-(cvds)"},{"issue":"3","key":"key20250924092908_B2","first-page":"225","article-title":"Cardiovascular event rates in a high atherosclerotic cardiovascular disease risk population: Estimates from Swedish population-based register data","volume":"5","year":"2019","journal-title":"European Heart Journal: Quality Care and Clinical Outcomes"},{"issue":"4","key":"key20250924092908_B3","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1002\/clc.23814","article-title":"Cardiovascular event rate and death in high-risk secondary prevention patient cohort in Finland: A registry study","volume":"45","year":"2022","journal-title":"Clinical Cardiology"},{"issue":"34","key":"key20250924092908_B4","doi-asserted-by":"crossref","first-page":"3227","DOI":"10.1093\/eurheartj\/ehab484","article-title":"2021 ESC Guidelines on cardiovascular disease prevention in clinical practice","volume":"42","year":"2021","journal-title":"European Heart Journal"},{"issue":"38","key":"key20250924092908_B5","doi-asserted-by":"crossref","first-page":"3720","DOI":"10.1093\/eurheartj\/ehad191","article-title":"2023 ESC guidelines for the management of acute coronary syndromes","volume":"44","year":"2023","journal-title":"European Heart Journal"},{"issue":"Suppl","key":"key20250924092908_B6","first-page":"S15","article-title":"The Fuster-CNIC-Ferrer cardiovascular polypill: A polypill for secondary cardiovascular prevention","volume":"201","year":"2015","journal-title":"International Journal of Cardiology"},{"issue":"11","key":"key20250924092908_B7","doi-asserted-by":"crossref","first-page":"967","DOI":"10.1056\/NEJMoa2208275","article-title":"Polypill strategy in secondary cardiovascular prevention","volume":"387","year":"2022","journal-title":"The New England Journal of Medicine"},{"issue":"10","key":"key20250924092908_B8","doi-asserted-by":"crossref","first-page":"e1488","DOI":"10.1016\/S2214-109X(23)00407-2","article-title":"The place of polypill in secondary prevention of stroke","volume":"11","year":"2023","journal-title":"The Lancet Global Health"},{"key":"key20250924092908_B9","unstructured":"World Health Organization (WHO). World Health Organization model list of essential medicines \u2013 23rd list, 2023 [Internet]. Geneva; 2023. 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Is there any interaction among the monocomponents?","volume":"74","year":"2021","journal-title":"Revista Espa\u00f1ola de Cardiolog\u00eda (English Ed)"},{"issue":"18","key":"key20250924092908_B20","doi-asserted-by":"crossref","first-page":"1994","DOI":"10.1177\/2047487316663873","article-title":"Challenges in secondary prevention after acute myocardial infarction: A call for action","volume":"23","year":"2016","journal-title":"European Journal of Preventive Cardiology"},{"issue":"1","key":"key20250924092908_B21","article-title":"Chronic polytherapy after myocardial infarction: The trade-off between hospital and community-based providers in determining adherence to medication","volume":"21","year":"2021","journal-title":"BMC Cardiovascular Disorders"},{"issue":"12","key":"key20250924092908_B22","doi-asserted-by":"crossref","first-page":"1874","DOI":"10.1097\/HJH.0000000000003480","article-title":"2023 ESH Guidelines for the management of arterial hypertension The Task Force for the 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