The decline in deaths from cardiovascular diseases in line with scientific developments between 1950-2010 was impressive. Despite these significant advances, cardiovascular (CV) diseases remain the leading cause of death worldwide. According to the World Health Organization (WHO) data, 17.9 million people die due to CV diseases every year, which corresponds to 31% of the total deaths worldwide. Therefore, for many CV diseases, there is still a need for improved treatment, and this is only possible with the development of new drugs.
Although investments in the previous decade have resulted in the development of many innovative drugs in the treatment of CV diseases, today, pharmaceutical companies are less enthusiastic about developing CV drugs, mainly due to financial and regulatory difficulties. Indeed, today, institutes, associations and even organizations such as WHO are taking over the sponsorship role that pharmaceutical industry players have abandoned. In parallel, cardiovascular pipeline activity is shifting from large pharmaceutical companies to small and medium-sized companies and from fastfollowing drugs to first-in classes. This transformation in CV drug discovery and development reveals significant challenges that require square up to. The aim of this chapter is to discuss the global challenges faced in CV drug discovery and development to find effective solutions.