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

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.