Drug therapies in the secondary prevention of cardiovascular diseases: Successes, shortcomings and future directions.

Cardiovascular diseases are the major cause of death and a significant cause of disability in the Western world and more recently threaten to pose an increasing health burden on developing nations. People with pre-existent vascular disease are those at highest risk for adverse cardiovascular outcomes and require aggressive secondary preventive therapies. Large strides have been made in the development of pharmacologic agents that intervene on various pathways implicated in atherogenesis, thus offering the ability to greatly impact on disease progression and to prevent events. Compelling data derived primarily from randomized controlled trials have shown the benefits of aspirin (or antiplatelet agents) and angiotensin converting enzyme (ACE) inhibitors (A), beta-blockers and blood pressure (B) and cholesterol-lowering drugs (C), particularly statins, in preventing recurrent events and improving survival. Taken together these data are the foundation for the simple, but important advice for secondary prevention - the ABCs. In addition, the evidence for the central role of lifestyle factors as determinants of risk has lead to increased efforts towards developing interventions aimed at modifying lifestyle patterns. Today, the biggest challenge remains in the implementation of proven effective therapies. Our focus should turn to educating physicians and patients alike regarding available therapies and their indications. In addition systematic, sustainable and globally applicable approaches to the secondary prevention of cardiovascular diseases need to be developed to truly realize the vast potential benefits of existing therapies.