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Published on: September 26, 2018
Global burden of CVD: focus on secondary prevention of cardiovascular disease
Sameer Bansilal1, José M Castellano2, Valentín Fuster1
1Mount Sinai Cardiovascular Institute, New York, USA; Centro Nacional de Investigaciones Cardiovasculares (CNIC) Carlos III, Madrid, Spain.
Insights
Cardiovascular disease (CVD) is a growing global health threat, especially in low-income countries. Poor medication adherence worsens outcomes and increases healthcare costs, highlighting a critical need for improved secondary prevention strategies.
Area of Science:
- Cardiology
- Public Health
- Pharmacology
Background:
- Cardiovascular disease (CVD) remains a leading cause of mortality and disability globally, with increasing prevalence in low and middle-income countries (LMIC).
- While coronary heart disease (CHD) mortality has declined in Europe and the USA due to acute care improvements, overall CHD prevalence is rising due to aging populations and increased cardiovascular risk factors.
- Pharmacologic interventions like aspirin, statins, and blood pressure-lowering agents are proven effective in secondary prevention of cardiovascular events and mortality.
Purpose of the Study:
- To review the global burden of cardiovascular disease.
- To assess the current status of secondary prevention therapies for CVD.
- To identify major barriers to treatment adherence in patients with chronic cardiovascular conditions.
Main Methods:
- Review of existing clinical trial data on pharmacologic interventions for secondary CVD prevention.
- Analysis of global trends in CVD prevalence, mortality, and treatment utilization.
- Examination of factors influencing medication adherence in patients with chronic CVD.
Main Results:
- Significant disparities exist in the use of indicated therapies worldwide, particularly in LMIC countries.
- Medication non-adherence is prevalent among chronic CVD patients, especially those on multiple medications.
- Poor adherence is linked to increased recurrent cardiovascular events and higher healthcare expenditures.
Conclusions:
- Despite effective treatments, substantial gaps in secondary prevention for CVD persist globally.
- Improving medication adherence is crucial for reducing recurrent cardiovascular events and healthcare costs.
- Addressing barriers to treatment adherence is essential for mitigating the growing global burden of CVD.
Abstract:
Despite encouraging advances in prevention and treatment of atherothrombosis, cardiovascular disease (CVD) remains a major cause of deaths and disability worldwide and will continue to grow mainly due to the increase in incidence in low and middle income countries (LMIC). In Europe and the United States of America (USA), coronary heart disease (CHD) mortality rates have decreased since the mid-1990s due to improvements in acute care, however the prevalence of CHD is increasing largely in part due to the overall aging of the population, increased prevalence of cardiovascular (CV) risk factors, and improved survival of patients after a CV event. Data from clinical trials has consistently proven the efficacy of pharmacologic interventions with aspirin, statins, and blood pressure (BP)-lowering agents in reducing the risk of CV events and total mortality in the ever growing pool of patients in secondary prevention. However, large gaps between indicated therapy and prescribed medication can be observed worldwide, with very low rates of use of effective therapies in LMIC countries. Adherence to medication is very poor in chronic patients, especially those treated with multiple pharmacologic agents, and has been directly correlated to a greater incidence of recurrent CV events and increase in direct and indirect healthcare costs. In this article, we review the global burden of CV disease, status of secondary prevention therapy and major barriers for treatment adherence.
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