Income variation associated with secondary prevention drug usage

January 01, 0001

Income variation associated with secondary prevention drug usage

Although most cardiovascular disease occurs in low-income and middle-income countries, little is known about the use of effective secondary prevention medications in these communities. The international researchers aimed to assess use of proven effective secondary preventive drugs (antiplatelet drugs, beta-blockers, angiotensin-converting-enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs), and statins) in individuals with a history of coronary heart disease or stroke. They recruited individuals aged 35—70 years from rural and urban communities in countries at various stages of economic development and assessed rates of previous cardiovascular disease (coronary heart disease or stroke) and use of proven effective secondary preventive drugs and blood-pressure- lowering drugs with standardised questionnaires, which were completed by telephone interviews, household visits, or on patient's presentation to clinics. They report estimates of drug use at national, community, and individual levels. They enrolled 153,996 adults from 628 urban and rural communities in countries with incomes classified as high (three countries), upper-middle (seven), lower-middle (three), or low (four) between January, 2003, and December, 2009.

5650 participants had a self-reported coronary heart disease event (median 5.0 years previously) and 2292 had stroke (4.0 years previously). Overall, few individuals with cardiovascular disease took antiplatelet drugs (25.3%), beta- blockers (17.4%), ACE inhibitors or ARBs (19.5%), or statins (14.6%). Use was highest in high-income countries (antiplatelet drugs 62.0%, beta- blockers 40.0%, ACE inhibitors or ARBs 49.8%, and statins 66.5%), lowest in low-income countries (8.8%, 9.7%, 5.2%, and 3.3%, respectively), and decreased in line with reduction of country economic status. Fewest patients received no drugs in high- income countries (11.2%), compared with 45.1% in upper middle-income countries, 69.3% in lower middle-income countries, and 80.2% in low-income countries. Drug use was higher in urban than rural areas (antiplatelet drugs 28.7% urban vs 21.3% rural, beta-blockers 23.5% vs 15.6%, ACE inhibitors or ARBs 22.8% vs 15.5%, and statins 19.9% vs 11.6%), with greatest variation in poorest countries. Country-level factors (eg, economic status) affected rates of drug use more than did individual-level factors (eg, age, sex, education, smoking status, body-mass index, and hypertension and diabetes statuses).

The researchers concluded: "Because use of secondary prevention medications is low worldwide—especially in low-income countries and rural areas—systematic approaches are needed to improve the long-term use of basic, inexpensive, and effective drugs."

There is so much room for improvement.

For the full abstract, click here.

The Lancet 378(9798):1231-1243, 1 October 2011 © 2011 Elsevier Inc
Use of secondary prevention drugs for cardiovascular disease in the community in high-income, middle- income, and low-income countries (the PURE Study): a prospective epidemiological survey. Salim Yusuf, Shofiqul Islam, Clara K Chow et al on behalf of the Prospective Urban Rural Epidemiology (PURE) Study Investigators. Correspondence to Salim Yusuf: yusufs@mcmaster.ca

Category: K. Circulatory. Keywords: secondary prevention, drugs, cardiovascular disease, community, income, prospective epidemiological survey, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 28 October 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.