The World Health Organization (WHO) Model List of Essential Medicines (EML) is a key tool for improving global access to medicines for all conditions, including cardiovascular diseases. A review paper, published Jan. 29 in the Journal of the American College of Cardiology, discusses efforts to align the list with contemporary clinical practice guidelines.

Sandeep P. Kishore, MD, PhD, et al., identified a global gap of missing or outdated medicines for cardiovascular disease on the EML and sought to fill the gap through evidence-based applications to modernize the list. The authors targeted medicines aligned with contemporary, guideline-directed, global cardiovascular care. Additions to the EML include statins, beta-blockers, losartan, clopidogrel and new indications for spironolactone. The authors also write that there have been three notable, recent rejections to petitions for inclusion on the EML: novel oral anticoagulants; combination of dual antihypertensive therapy; and fixed-dose combination, or polypill, therapy.

The authors observed key factors that affect inclusion of medicines on the WHO EML: 1) cost and cost-effectiveness; 2) presence in clinical practice guidelines; 3) feedback loops; and 4) community engagement. They write that each of these factors deserve future considerations. Additions to the EML have been known to lead to a reduction in medication prices. According to the authors, adapting clinical guidelines from high-income country settings to the low- and middle-income context holds the promise of not only strengthening future EML applications, but also ensuring access to essential medicines. They add that as new medications are added to the list, it is important to modernize the EML by removing medicines from the list when they are ineffective or harmful. Finally, the global cardiovascular disease community can benefit from enhanced engagement with a diverse array of stakeholders, including the next generation of health workers, patients and advocates. They conclude that moving forward, modernizing national EMLs to the WHO EML based on country needs is an important area of focus.

"WHO and national EMLs represent a collective opportunity and responsibility toward improving access to essential medicines and improving cardiovascular health," the authors write. "We believe that the clinical cardiovascular disease community has a key role to play as petitioners, advisors, and advocates. Our work represents our collective, iterative, and expanding set of lessons learned individually – and as a group – over the past decade to modernize the WHO EML and advocate for expanded access to cardiovascular disease medications worldwide. We hope to socialize and disseminate these lessons to stimulate others to embark on similar efforts to modernize WHO EML and national EMLs."

Keywords: Hydroxymethylglutaryl-CoA Reductase Inhibitors, World Health Organization, Spironolactone, Losartan, Cost-Benefit Analysis, Antihypertensive Agents, Drugs, Essential, Ticlopidine, Cardiovascular Agents, Adrenergic beta-Antagonists, Cardiovascular Diseases, Anticoagulants

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