Priority Medicines for Europe and the World 2013 Update. Background Paper 6 - Priority Diseases and Reasons for Inclusion. BP 6.03 - Ischaemic Heart Disease
(2013; 58 pages)

Abstract

In 2004 Warren Kaplan and Richard Laing wrote the "Priority Medicines for Europe and the World Report". In this report they placed great emphasis on the background paper written by Bruce Neal titled "Secondary Prevention of Cardiovascular Disease: Fixed Dose Combinations." (http://archives.who.int/prioritymeds/report/background/cardiovascular. doc). In the 2004 report Kaplan and Laing stated "The simple solution to this deficiency (in the effective treatment of patients with proven cardiovascular disease) is to develop and test a fixed-dose combination (FDC) product of these proven effective medicines. The research agenda proposed in this section is different to that of the other sections because this approach offers the greatest potential short- to-medium term impact of all of the possible research activities in this Report."(Page 58). This background paper to the 2013 update of the Priority Medicines for Europe and the World reports on the work that has been done since 2004 making the case that what was proposed in 2004 has now been undertaken and that the next stage is to undertake large scale pan European and global clinical trials to understand the place of "polypills" in the treatment of individuals who have suffered from cardiovascular and/or cerebrovascular events. There have been two large scale clinical trials funded in this area. One of these studies (the UMPIRE trial) has since reported positive results as outlined in detail in this background paper. This report updates the information on this topic.

This report updates the potential information on this topic and therefore continues to focus on secondary prevention among patients who have already suffered a cardiovascular event. The majority of such patients have IHD, but a significant minority have cerebrovascular disease or peripheral vascular disease.

In addition to secondary prevention with the polypill, a number of other pharmacological approaches to prevention and treatment of IHD will need to be researched in order to provide more effective, safer and individualized intervention strategies. These include the development of new lipid-lowering drugs; pharmacological means to address novel mechanistic concepts of vessel wall damage and protect against conditions such as chronic inflammation and local angiogenesis; and regenerative medicine/cell therapy approaches. Similarly, new pharmacological treatment strategies need to be developed for heart failure and arrhythmias, frequent consequences of IHD.

 
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