I have never personally seen a randomized study with anywhere near 40k+ participants for any cardiology or cancer-related treatment. Recruitment for this vaccine trial is much easier than studies with specific conditions like heart attack, stroke, or cancers, simply due to their incidence rates. In cardiology, a 20k subject study is massive in scale.

All this to say that for the pivotal phase 3 trials submitted to FDA for approval, I would suppose almost all existing drugs had much fewer than 40k participants.