Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO) Scientific Statement on the Simplification of the Drug Regimen for Secondary Cardiovascular Prevention

Overview

Journal Eur Heart J Suppl

Publisher Oxford University Press

Date 2024 May 24

PMID 38784670

Authors

Leonardo De Luca

Stefania Angela Di Fusco

Gianmarco Iannopollo

Raffaella Mistrulli

Vittoria Rizzello

Alberto Aimo

Alessandro Navazio

Claudio Bilato

Marco Corda

Massimo Di Marco

Giovanna Geraci

Attilio Iacovoni

Massimo Milli

Vittorio Pascale

Carmine Riccio

Pietro Scicchitano

Emanuele Tizzani

Domenico Gabrielli

Massimo Grimaldi

Furio Colivicchi

Fabrizio Oliva

Affiliations

Soon will be listed here.

Abstract

The issue of suboptimal drug regimen adherence in secondary cardiovascular prevention presents a significant barrier to improving patient outcomes. To address this, the utilization of drug combinations, specifically single pill combinations (SPCs) and polypills, was proposed as a strategy to simplify treatment regimens. This approach aims to enhance treatment accessibility, affordability, and adherence, thereby reducing healthcare costs and improving patient health. The document is an Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO) scientific statement on simplifying drug regimens for secondary cardiovascular prevention. It discusses the underuse of treatments despite available, effective, and accessible options, highlighting a significant gap in secondary prevention across different socio-economic statuses and countries. The statement explores barriers to implementing evidence-based treatments, including patient, healthcare provider, and system-related challenges. The paper also reviews international guidelines, the role of SPCs and polypills in clinical practice, and their economic impact, advocating for their use in secondary prevention to improve patient outcomes and adherence.

References

Rea F, Corrao G, Merlino L, Mancia G . Early cardiovascular protection by initial two-drug fixed-dose combination treatment vs. monotherapy in hypertension. Eur Heart J. 2018; 39(40):3654-3661. DOI: 10.1093/eurheartj/ehy420. View

Koh J, Park Y, Tantry U, Ahn J, Kang M, Kim K . Pharmacodynamic effects of a new fixed-dose clopidogrel-aspirin combination compared with separate administration of clopidogrel and aspirin in patients treated with coronary stents: The ACCEL-COMBO trial. Platelets. 2016; 28(2):187-193. DOI: 10.1080/09537104.2016.1206197. View

Liuzzo G, Patrono C . A SECURE polypill as a strategy at the heart of secondary prevention. Eur Heart J. 2022; 43(43):4534-4535. DOI: 10.1093/eurheartj/ehac518. View

Mazzaglia G, Ambrosioni E, Alacqua M, Filippi A, Sessa E, Immordino V . Adherence to antihypertensive medications and cardiovascular morbidity among newly diagnosed hypertensive patients. Circulation. 2009; 120(16):1598-605. DOI: 10.1161/CIRCULATIONAHA.108.830299. View

Gonzalez-Juanatey J, Cordero A, Castellano J, Masana L, Dalmau R, Ruiz E . The CNIC-Polypill reduces recurrent major cardiovascular events in real-life secondary prevention patients in Spain: The NEPTUNO study. Int J Cardiol. 2022; 361:116-123. DOI: 10.1016/j.ijcard.2022.05.015. View

Byrne R, Rossello X, Coughlan J, Barbato E, Berry C, Chieffo A . 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J. 2023; 44(38):3720-3826. DOI: 10.1093/eurheartj/ehad191. View

Yusuf S, Islam S, Chow C, Rangarajan S, Dagenais G, Diaz R . Use of secondary prevention drugs for cardiovascular disease in the community in high-income, middle-income, and low-income countries (the PURE Study): a prospective epidemiological survey. Lancet. 2011; 378(9798):1231-43. DOI: 10.1016/S0140-6736(11)61215-4. View

De Luca L, Riccio C, Navazio A, Valente S, Cipriani M, Corda M . [ANMCO Position paper: Management of hypercholesterolemia in patients with acute coronary syndrome]. G Ital Cardiol (Rome). 2023; 24(3):229-240. DOI: 10.1714/3980.39627. View

Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren M . European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted.... Eur Heart J. 2012; 33(13):1635-701. DOI: 10.1093/eurheartj/ehs092. View

10.

Salam A, Kanukula R, Atkins E, Wang X, Islam S, Kishore S . Efficacy and safety of dual combination therapy of blood pressure-lowering drugs as initial treatment for hypertension: a systematic review and meta-analysis of randomized controlled trials. J Hypertens. 2019; 37(9):1768-1774. DOI: 10.1097/HJH.0000000000002096. View

11.

Gaziano T, Pandya A, Sy S, Jardim T, Ogden J, Rodgers A . Modeling the cost effectiveness and budgetary impact of Polypills for secondary prevention of cardiovascular disease in the United States. Am Heart J. 2019; 214:77-87. DOI: 10.1016/j.ahj.2019.04.020. View

12.

Komajda M, Cosentino F, Ferrari R, Kerneis M, Kosmachova E, Laroche C . Profile and treatment of chronic coronary syndromes in European Society of Cardiology member countries: The ESC EORP CICD-LT registry. Eur J Prev Cardiol. 2021; 28(4):432-445. DOI: 10.1177/2047487320912491. View

13.

De Luca L, Arca M, Temporelli P, Meessen J, Riccio C, Bonomo P . Current lipid lowering treatment and attainment of LDL targets recommended by ESC/EAS guidelines in very high-risk patients with established atherosclerotic cardiovascular disease: Insights from the START registry. Int J Cardiol. 2020; 316:229-235. DOI: 10.1016/j.ijcard.2020.05.055. View

14.

Visseren F, Mach F, Smulders Y, Carballo D, Koskinas K, Back M . 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2021; 42(34):3227-3337. DOI: 10.1093/eurheartj/ehab484. View

15.

Ray K, Reeskamp L, Laufs U, Banach M, Mach F, Tokgozoglu L . Combination lipid-lowering therapy as first-line strategy in very high-risk patients. Eur Heart J. 2021; 43(8):830-833. DOI: 10.1093/eurheartj/ehab718. View

16.

Marx N, Federici M, Schutt K, Muller-Wieland D, Ajjan R, Antunes M . 2023 ESC Guidelines for the management of cardiovascular disease in patients with diabetes. Eur Heart J. 2023; 44(39):4043-4140. DOI: 10.1093/eurheartj/ehad192. View

17.

Boytsov S, Burtsev Y, Khomitskaya Y, Karpov Y . Effectiveness and Tolerability of the Single-Pill Combination of Bisoprolol and Perindopril in Patients with Arterial Hypertension and Stable Coronary Artery Disease in Daily Clinical Practice: The STYLE Study. Adv Ther. 2021; 38(6):3299-3313. PMC: 8189988. DOI: 10.1007/s12325-021-01754-2. View

18.

Castellano J, Pocock S, Bhatt D, Quesada A, Owen R, Fernandez-Ortiz A . Polypill Strategy in Secondary Cardiovascular Prevention. N Engl J Med. 2022; 387(11):967-977. DOI: 10.1056/NEJMoa2208275. View

19.

Di Matteo S, Moumene S, Colombo G, De Luca L . [Economic evaluation of a fixed-dose combination (acetylsalicylic acid and rosuvastatin) in the cardiovascular context]. G Ital Cardiol (Rome). 2024; 25(1 Suppl 2):e4-e8. DOI: 10.1714/4182.41699. View

20.

Colivicchi F, Abrignani M, Santini M . [Therapeutic non-adherence: the hidden risk factor]. G Ital Cardiol (Rome). 2010; 11(5 Suppl 3):124S-127S. View