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Dr. Shanthi Mendis Coordinator, Cardiovascular Diseases World Health Organization. Cardiovascular Diseases 2 ry Prevention. Magnitude of CVD burden Potential of 2 ry prevention FDC ; scaling up 2 ry Prevention. Deaths due to CVD. World. Europe (25). CVD 16.3 m (29%). - PowerPoint PPT Presentation
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Cardiovascular DiseasesCardiovascular Diseases2 ry Prevention2 ry Prevention
Cardiovascular DiseasesCardiovascular Diseases2 ry Prevention2 ry Prevention
Dr. Shanthi Mendis Coordinator, Cardiovascular Diseases
World Health Organization
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•Magnitude of CVD burden•Potential of 2 ry prevention •FDC ; scaling up 2 ry Prevention
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Deaths due to CVD
CVD 16.3 m (29%) CVD 1.8M (42%)
World Europe (25)
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Disease Burden due to CVD
CVD 9 % CVD 22%
World Europe (25)
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Number of Cardiovascular Deaths Projected to 2020
Number of Cardiovascular Deaths Projected to 2020
Millions 2002
2020
2002 2020
02000000400000060000008000000
100000001200000014000000160000001800000020000000
LowerIncome
HigherIncome
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Commonality of interest between Commonality of interest between Europe and the WorldEurope and the World
Commonality of interest between Commonality of interest between Europe and the WorldEurope and the World
IHD and stroke are two leading causes of death in Europe and the world
Closing pharmaceutical gaps in Europe has benefits for the world
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Prevention and Control of CVDPrevention and Control of CVDPrevention and Control of CVDPrevention and Control of CVD
Primary prevention
Secondary prevention
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The potential of secondary preventionThe potential of secondary prevention The potential of secondary preventionThe potential of secondary prevention
RR reduction 2-year event rate None ----- 8.0% Aspirin 25% 6.0% B B 25% 4.5% Statin 30% 3.0% ACEI 25% 2.3%
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Joint effects of BP / TC lowering and antiplatelet therapy
0
5
10
15
20
25
Baseline Aspirin add BPRx
addstatin
10 yr CV risk
RR reduction 20% 40% 55%
10
63
43
84
66
0 20 40 60 80 100
Statins
BB
ACEI
Aspirin
Overall Percentage on Rx
EUROASPIRE Survey EUROASPIRE Survey
Lancet 2001;357:996-1001Percentage
Drugs
11
2357
4034
4643
5660
4747
36
0 20 40 60 80 100
BelgiumFinlandFrance
GermanyIreland
ItalyNetherlands
SpainSweden
UKGreece
Percentage of patients with BC goals achieved
EUROASPIRE II Survey EUROASPIRE II Survey
Countries
Percentage
12
5550
4436
5051
4936
554952
0 20 40 60 80 100
BelgiumFinlandFrance
GermanyIreland
ItalyNetherlands
SpainSweden
UKGreece
Percentage of patients with BP goals achieved
EUROASPIRE II Survey EUROASPIRE II Survey
Countries
Percentage
13
29
53
66
45
0 20 40 60 80 100
Statins
BB
ACEI
Aspirin
Overall Percentage in 10 countries
Secondary Prevention of CHD Secondary Prevention of CHD
WHO PREMISE 2003Percentage
Drugs
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Possible reasons for low uptakePossible reasons for low uptakePossible reasons for low uptakePossible reasons for low uptake
Provider not prescribingNot affordablePoor adherence; complexity of Rx Lack of access to servicesFragmented followup
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Added value of a Fixed Dose Added value of a Fixed Dose CombinationCombination
Added value of a Fixed Dose Added value of a Fixed Dose CombinationCombination
Improved adherenceReduced costs
(packaging/storage/distribution/low cost generic)
Less medication errors Improve access to effective treatment
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Drawbacks of a Fixed Dose Drawbacks of a Fixed Dose CombinationCombination
Drawbacks of a Fixed Dose Drawbacks of a Fixed Dose CombinationCombination
Reduced capacity of physician to tailor therapy/dose
Therapy cannot be individualizedSide effects of one result in
discontinuation of all
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FDC for Patients with CHDFDC for Patients with CHDFDC for Patients with CHDFDC for Patients with CHD
Low dose antiplatelet (aspirin 75 mg)
Full dose of a statin (simvastatin 40 mg)
Full dose of an ACEI (lisinopril 10 mg)
Half dose of a BB (atenolol 25 mg)
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FDC for Patients with CeVDFDC for Patients with CeVDFDC for Patients with CeVDFDC for Patients with CeVD
Low dose antiplatelet (aspirin 75 mg)
Full dose of a statin (simvastatin 40 mg)
Full dose of an ACEI (lisinopril 10 mg)
Half dose of a diuretic (HCT 12.5 mg)
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Potential for Europe Potential for Europe Potential for Europe Potential for Europe
If there are 40 million individuals with a 10 year CV risk of 25%
In the absence of treatment every year there will be 1 million strokes and HA
About half these could be averted (10 year CV risk 11.25%)
Treat 70 over 1 year to avert 1 attack
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Key research issues in developmentKey research issues in developmentKey research issues in developmentKey research issues in development
Formulation Intellectual property Regulation Manufacture and quality assurance Bioequivalence and stability Comparability of pharmaco-dynamics and pharmaco-
kinetics
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FDC;Clinical researchFDC;Clinical researchFDC;Clinical researchFDC;Clinical research
Effects on intermediate outcomes
Enhanced adherence
Prospective metanalysis
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Europe; CVD projected to increaseEurope; CVD projected to increase Europe; CVD projected to increaseEurope; CVD projected to increase
Scaling up 2ry prevention is a key strategyPoor uptake of effective medications
Innovative strategy FDC;modest investment
No incentives for pharma/ No tradition
Who should step in ? public sector? EU?