The challenge of polypharmacy in cardiovascular medicine

Massimo Volpe, Diana Chin, Francesco Paneni

Research output: Contribution to journalArticle

43 Citations (Scopus)

Abstract

Albeit great efforts in reducing the burden of cardiovascular diseases (CVD), their prevalence continues to grow worldwide. Among the causes for this rising burden, the upcoming pandemic of obesity and diabetes further enhances the estimates of CV mortality and healthcare costs over the next decades. Nevertheless, advances in CVD treatment has increased life-expectancy, and future perspectives announce a growing aging population, with increasing comorbid conditions predisposing to CVD. Despite the emphasis on primary prevention, CV risk factors are still poorly controlled and a further need for CV drugs is upcoming. In chronic CVD such as hypertension, ischemic heart disease (IHD) and heart failure, the progressive use of multiple drugs is common and is recommended by international guidelines. However, the chronic use of five or more medications, defined as polypharmacy, has shown to be neither always efficacious nor safe. Polypharmacy is associated with an increased morbidity and costs. The use of multiple medications often leads to inappropriate drug use, underprescription, low adherence and side effects. In order to overcome these issues, a fixed-dose combination pill ('polypill') for the prevention of CVD has been recently proposed. A hypothetical meta-analysis estimated for this strategy a reduction of IHD and stroke by 88 and 80% respectively in people aged 55 or over. Such polypill can be cost effective and increase patient adherence. However, large randomized trials are required to define its impact on clinical outcomes. This review will focus on challenges of polypharmacy in CV medicine, illustrating potential options to face this emerging crisis.

Original languageEnglish
Pages (from-to)9-17
Number of pages9
JournalFundamental and Clinical Pharmacology
Volume24
Issue number1
DOIs
Publication statusPublished - Feb 2010

Fingerprint

Polypharmacy
Cardiovascular Diseases
Medicine
Myocardial Ischemia
Pharmaceutical Preparations
Costs and Cost Analysis
Pandemics
Primary Prevention
Patient Compliance
Life Expectancy
Health Care Costs
Meta-Analysis
Chronic Disease
Heart Failure
Obesity
Stroke
Guidelines
Hypertension
Morbidity
Mortality

Keywords

  • Cardiovascular disease
  • Challenge
  • Polypharmacy
  • Preventive polypill

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)

Cite this

The challenge of polypharmacy in cardiovascular medicine. / Volpe, Massimo; Chin, Diana; Paneni, Francesco.

In: Fundamental and Clinical Pharmacology, Vol. 24, No. 1, 02.2010, p. 9-17.

Research output: Contribution to journalArticle

Volpe, Massimo ; Chin, Diana ; Paneni, Francesco. / The challenge of polypharmacy in cardiovascular medicine. In: Fundamental and Clinical Pharmacology. 2010 ; Vol. 24, No. 1. pp. 9-17.
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