The top 10 cardiovascular drugs in the world

Cardiovascular drugs may not be the largest field in terms of sales. That title belongs to cancer drugs, followed by diabetes meds. Cardiovascular drugs are not the fastest-growing market, either; in fact, by 2022, two of its key segments are expected to sell slightly less than they did in 2016.

By 2022, two of its key segments are expected to sell slightly less than they did in 2016.

But heart disease and related ailments remain the biggest cause of death in the U.S. Poor diets and lack of exercise, plus a surge of aging baby boomers, are expanding the number of people who’ll need CV drugs in the years ahead. Demand for cholesterol fighters and blood pressure remedies will rise as that treatment pool grows and longer-lived patients stay on treatments for extended periods. And that, in turn, means many billions in sales for the companies that continue to hawk branded meds.

Competition, particularly with low-cost generics, will be fierce, however; the cholesterol drug market is expected to be worth just $13.4 billion in 2022, a slight decline from last year, while hypertension remedies are also expected to shrink a bit, to $24.4 billion, according to Evaluate Pharma estimates made earlier this year.

We’ve put together this list as a state-of-the-market snapshot, coinciding with the European Society of Cardiology (ESC) this week in Barcelona. And as the data presented at ESC will show, cardiovascular drugs are tough and expensive to develop. It takes enormous clinical trials to prove a CV drug’s worth these days, with the FDA’s intense eye on safety and payers’ demands for real-world outcomes, not just surrogate-marker performance.

But companies are taking the risk; just consider Amgen’s series of studies on its PCSK9 cholesterol med Repatha, or Sanofi and Regeneron’s own slate for its competing Praluent. Or Novartis’ Entresto, a heart failure drug for which it recently announced a whole new series of trials.

The 10 drugs we’re profiling here represent the largest in the market by global 2016 sales, excluding those that faced generic competition throughout the year. We included drugs that kept their exclusivity into last year, such as AstraZeneca’s Crestor, which faced generics as of July. But we left out brands that went generic prior to January 1, 2016, including Pfizer’s Lipitor, which is still bringing in blockbuster branded sales—$1.75 billion last year, to be exact. All the sales numbers are courtesy of EvaluatePharma, which ran its exclusive analysis for us in August 2017.

Expect the ranks to shift considerably next year - the top three drugs are now fighting generic rivals, with Vytorin, which lost exclusivity in April, the most recent victim. Let's see how it goes on...