Global burden of CVD: focus on secondary prevention of cardiovascular disease

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.

Self-reported hypertension, dyslipidemia and hyperuricemia management by Italian Internal Medicine Units: a national survey of the FADOI Study Group in Cardiovascular Medicine

“…20 Internists often treat patients with dyslipidemia, and a lipidology center was found in the 46% of IMUs. These centers were able to perform an average of 300 to 1000 visits per year, with an average time of consultation greater than 15 min.…”

Perceptions and Acceptance of mHealth in Patients With Cardiovascular Diseases: A Cross-Sectional Study (Preprint)

“…Cardiovascular diseases is a major cause of deaths and disability worldwide, and will continue to grow mainly due to the increase in low and middle income countries [1]. China is no exception.…”

“…For example, about 2.9 million people in China has a cardiovascular disease, and this number will continue to grow rapidly in the next decade [2]. Adherence to secondary prevention of CVD is critical to achieving improved health outcomes, quality of life, and cost-effective health care [1]. However, the adherence rate to secondary prevention for patients with CVD is relevant low.…”

“…For example, a meta-analysis study on 376,162 patients shows the adherence across all studies to drugs that prevent cardiovascular diseases was 57% [3].The magnitude and impact of poor adherence in developing countries is assumed to be even higher given the paucity of health resources and inequities in access to health care like China [4]. Poor adherence in chronic patients has been directly correlated to a greater incidence of recurrent cardiovascular events and increase in direct and indirect healthcare costs [1].…”

User Preferences and Persona Design for an mHealth Intervention to Support Adherence to Cardiovascular Disease Medication in Singapore: A Multi-Method Study (Preprint)

“…Although medication has shown to be effective in preventing cardiovascular events associated with ASCVD 17 , patients may exhibit suboptimal adherence due to the long term management required, disease misperceptions, poor patient-physician relationship, weak social support and comorbidities [18][19][20][21] . The txt2heart trial is an international collaboration evaluating the efficacy and safety of SMS on clinical outcomes and adherence in different countries including Colombia, Ghana, India and Singapore.…”