Prescription appropriateness in cardiovascular medicine: an ethical, clinical and pharmacoeconomic approach.

Aims: The aim of this short text is to list and discuss the main points to be considered in the evaluation of the appropriateness of a pharmacological intervention to prevent cardiovascular disease. Data synthesis: In order to improve the cost-effectiveness ratio of the available preventive drugs, it is necessary to take in account the epidemiology of the disease, the correct and complete risk stratification of the single subjects, to know the target we have to achieve, to choose evidence-based and adequately dosed drugs, to support the adherence and persistence of the patients. The most common mistake seen in clinical practise are the use of drug on the basis of their phenotypic effect (beyond the physiopathological one), underdosed treatments (both as compared to the ones demonstrated as efficacious in large randomized clinical trials and to the ones useful to achieve the desired available target) and too short treatments (the most part of preventive trials do not show any treatment efficacy before 3 years of treatment, where in clinical practise 1/3 of hypertensive patients and 2/3 of hypercholesterolemic ones stop their treatment before the end of the first year). All these mistakes are cause of resources wasting, and consequently reduction of cost-effectiveness ratio of efficacious treatments. Conclusion: The evaluation of the appropriateness of a pharmacological intervention is complex and requires to consider numerous factors.