Cardiovascular diseases, how to promote therapeutic adherence

ANY cure doesn’t work if you don’t take it. It seems a self-evident statement, but unfortunately, when talking about primary and secondary prevention of cardiovascular diseases and the control of risk factors, this is often the reality. The doctor prescribes a treatment and the patient “forgets”, more or less voluntarily, to take it. The result is that the goals of the therapies, in terms of risk factors, are not met. “Therapeutic adherence is a key factor in controlling cholesterol, blood pressure or blood sugar, so much so that it can be considered, if not optimal, a possible additional risk factor for the heart and arteries – he remembers Pasquale Perrone Filardi, Professor of Cardiology at the Federico II University of Naples and elected president of the Italian Society of Cardiology (Sic). These patients, however, may suffer from different diseases at the same time and therefore perhaps need more drugs every day: for this reason, it is always necessary to consider the use of fixed combinations of drugs in the cardiovascular field, or single tablets that contain several active ingredients capable of control various cardiovascular risk factors, such as hypertension and dyslipidemia. With this strategy it is possible to limit the “appointments” with the therapies and therefore make adherence easier “.

The dimensions of the phenomenon ‘lack of adherence ‘ are really impressive: according to the data emerging from the most recent international research, over 43 percent of hypertensive patients under treatment are non-adherent, as well as more than 50 percent of those who have suffered from cardiovascular diseases and ischemic events Non-adherence is attributable to various factors: the complexity of therapeutic regimens and the availability of pharmacological solutions that simplify treatment, such as polypills.

The value of tailor-made care

Eleven Italian experts, within the project Pianopolis organized by Helaglobe and carried out with the unconditional support of the Servier Group in Italy, they have recently analyzed the impact of the lack of therapeutic adherence from a clinical, economic, technological and organizational point of view. A multidisciplinary consensus document emerged on the potential advantages of using pre-established combinations of drugs with different action for the control of cardiovascular risk factors, published in Journal of Cardiovascular Medicine. In particular, attention was focused on the value of a single tablet containing at least two active ingredients in favoring the effectiveness of the treatment for LDL cholesterol and blood pressure. “According to the experts, after the analyzes carried out, the polypill can represent a valuable therapeutic strategy, effective in reducing cardiovascular events, blood pressure and lipids, cardiovascular risk and the” weight “of therapies – recalls Perrone Filardi, first signatory of the In a nutshell, reducing the number of tablets to be taken can positively affect adherence and it is necessary that this concept must increasingly be part of medical culture, also through training projects that allow the combinations to be used appropriately and therefore to manage them. at best. ”And then, what matters is always the doctor-patient relationship.

If it is true that the causes of non-adherence can be different from forgetfulness, complexity, side effects and lack of awareness of the severity of the disease, it is undeniable that adherence is higher in conditions in which the person is well informed about the disease. your condition. “In chronic diseases, which often do not cause symptoms as happens precisely in the case of hypertension and high cholesterol, thinking about the current benefits is difficult for the patient – concludes Perrone Filardi. For this reason it is necessary that every time a drug is prescribed it is essential that the reason for the therapeutic choice is explained in a clear and timely manner by the doctor, who must be firmly convinced of the need to reach the therapeutic target for each pathology and must always be available for patient involvement. The patient, in turn, must be fully aware of the importance of scrupulously following the agreed therapeutic plan, which must obviously be effective, but also well tolerated and easy to follow ”.