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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

Summary Background 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. We aimed to assess use of proven effective secondary preventive drugs (antiplatelet drugs, β blo... Full description

Journal Title: The Lancet (British edition) 2011, Vol.378 (9798), p.1231-1243
Main Author: Yusuf, Salim, Prof
Other Authors: Islam, Shofiqul, MSc , Chow, Clara K, PhD , Rangarajan, Sumathy, MSc , Dagenais, Gilles, Prof , Diaz, Rafael, MD , Gupta, Rajeev, PhD , Kelishadi, Roya, Prof , Iqbal, Romaina, PhD , Avezum, Alvaro, MD , Kruger, Annamarie, Prof , Kutty, Raman, Prof , Lanas, Fernando, MD , Lisheng, Liu, Prof , Wei, Li, Prof , Lopez-Jaramillo, Patricio, Prof , Oguz, Aytekin, MD , Rahman, Omar, Prof , Swidan, Hany, MD , Yusoff, Khalid, Prof , Zatonski, Witold, Prof , Rosengren, Annika, Prof , Teo, Koon K, Prof
Format: Electronic Article Electronic Article
Language: English
Subjects:
Abridged Index Medicus
Adrenergic beta-Antagonists - therapeutic use
Adult
Aged
Angiotensin-Converting Enzyme Inhibitors - therapeutic use
Antihypertensive Agents - therapeutic use
Biological and medical sciences
Cardiovascular agents
Cardiovascular Agents - therapeutic use
Cardiovascular disease
Cardiovascular diseases
Cardiovascular Diseases - prevention & control
Care and treatment
Community
Coronary Disease - drug therapy
Data Collection
Developed Countries
Developing Countries
Drug use
Drug Utilization
Economic development
Epidemiology
Female
General aspects
Health aspects
Households
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use
Internal Medicine
Low income groups
Male
MEDICAL AND HEALTH SCIENCES
Medical sciences
MEDICIN OCH HÄLSOVETENSKAP
Middle Aged
Miscellaneous
Platelet Aggregation Inhibitors - therapeutic use
Public health. Hygiene
Public health. Hygiene-occupational medicine
Rural Population
Secondary Prevention
Socioeconomic factors
Stroke
Stroke - drug therapy
Studies
Urban Population
Quelle: Alma/SFX Local Collection
Publisher: Kidlington: Elsevier Ltd
ID: ISSN: 0140-6736
Zum Text:
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recordid: cdi_swepub_primary_oai_gup_ub_gu_se_150171
title: 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
format: Article
creator:
  • Yusuf, Salim, Prof
  • Islam, Shofiqul, MSc
  • Chow, Clara K, PhD
  • Rangarajan, Sumathy, MSc
  • Dagenais, Gilles, Prof
  • Diaz, Rafael, MD
  • Gupta, Rajeev, PhD
  • Kelishadi, Roya, Prof
  • Iqbal, Romaina, PhD
  • Avezum, Alvaro, MD
  • Kruger, Annamarie, Prof
  • Kutty, Raman, Prof
  • Lanas, Fernando, MD
  • Lisheng, Liu, Prof
  • Wei, Li, Prof
  • Lopez-Jaramillo, Patricio, Prof
  • Oguz, Aytekin, MD
  • Rahman, Omar, Prof
  • Swidan, Hany, MD
  • Yusoff, Khalid, Prof
  • Zatonski, Witold, Prof
  • Rosengren, Annika, Prof
  • Teo, Koon K, Prof
subjects:
  • Abridged Index Medicus
  • Adrenergic beta-Antagonists - therapeutic use
  • Adult
  • Aged
  • Angiotensin-Converting Enzyme Inhibitors - therapeutic use
  • Antihypertensive Agents - therapeutic use
  • Biological and medical sciences
  • Cardiovascular agents
  • Cardiovascular Agents - therapeutic use
  • Cardiovascular disease
  • Cardiovascular diseases
  • Cardiovascular Diseases - prevention & control
  • Care and treatment
  • Community
  • Coronary Disease - drug therapy
  • Data Collection
  • Developed Countries
  • Developing Countries
  • Drug use
  • Drug Utilization
  • Economic development
  • Epidemiology
  • Female
  • General aspects
  • Health aspects
  • Households
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use
  • Internal Medicine
  • Low income groups
  • Male
  • MEDICAL AND HEALTH SCIENCES
  • Medical sciences
  • MEDICIN OCH HÄLSOVETENSKAP
  • Middle Aged
  • Miscellaneous
  • Platelet Aggregation Inhibitors - therapeutic use
  • Public health. Hygiene
  • Public health. Hygiene-occupational medicine
  • Rural Population
  • Secondary Prevention
  • Socioeconomic factors
  • Stroke
  • Stroke - drug therapy
  • Studies
  • Urban Population
ispartof: The Lancet (British edition), 2011, Vol.378 (9798), p.1231-1243
description: Summary Background 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. We aimed to assess use of proven effective secondary preventive drugs (antiplatelet drugs, β blockers, angiotensin-converting-enzyme [ACE] inhibitors or angiotensin-receptor blockers [ARBs], and statins) in individuals with a history of coronary heart disease or stroke. Methods In the Prospective Urban Rural Epidemiological (PURE) study, we recruited individuals aged 35–70 years from rural and urban communities in countries at various stages of economic development. We 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. We report estimates of drug use at national, community, and individual levels. Findings We 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 [IQR 2·0–10·0]) and 2292 had stroke (4·0 years previously [2·0–8·0]). Overall, few individuals with cardiovascular disease took antiplatelet drugs (25·3%), β blockers (17·4%), ACE inhibitors or ARBs (19·5%), or statins (14·6%). Use was highest in high-income countries (antiplatelet drugs 62·0%, β 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 (ptrend
language: eng
source: Alma/SFX Local Collection
identifier: ISSN: 0140-6736
fulltext: fulltext
issn:
  • 0140-6736
  • 1474-547X
  • 1474-547X
url: Link


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titleUse 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
sourceAlma/SFX Local Collection
creatorYusuf, Salim, Prof ; Islam, Shofiqul, MSc ; Chow, Clara K, PhD ; Rangarajan, Sumathy, MSc ; Dagenais, Gilles, Prof ; Diaz, Rafael, MD ; Gupta, Rajeev, PhD ; Kelishadi, Roya, Prof ; Iqbal, Romaina, PhD ; Avezum, Alvaro, MD ; Kruger, Annamarie, Prof ; Kutty, Raman, Prof ; Lanas, Fernando, MD ; Lisheng, Liu, Prof ; Wei, Li, Prof ; Lopez-Jaramillo, Patricio, Prof ; Oguz, Aytekin, MD ; Rahman, Omar, Prof ; Swidan, Hany, MD ; Yusoff, Khalid, Prof ; Zatonski, Witold, Prof ; Rosengren, Annika, Prof ; Teo, Koon K, Prof
creatorcontribYusuf, Salim, Prof ; Islam, Shofiqul, MSc ; Chow, Clara K, PhD ; Rangarajan, Sumathy, MSc ; Dagenais, Gilles, Prof ; Diaz, Rafael, MD ; Gupta, Rajeev, PhD ; Kelishadi, Roya, Prof ; Iqbal, Romaina, PhD ; Avezum, Alvaro, MD ; Kruger, Annamarie, Prof ; Kutty, Raman, Prof ; Lanas, Fernando, MD ; Lisheng, Liu, Prof ; Wei, Li, Prof ; Lopez-Jaramillo, Patricio, Prof ; Oguz, Aytekin, MD ; Rahman, Omar, Prof ; Swidan, Hany, MD ; Yusoff, Khalid, Prof ; Zatonski, Witold, Prof ; Rosengren, Annika, Prof ; Teo, Koon K, Prof ; on behalf of the Prospective Urban Rural Epidemiology (PURE) Study Investigators ; Prospective Urban Rural Epidemiology (PURE) Study Investigators ; Sahlgrenska akademin ; Institutionen för medicin, avdelningen för akut och kardiovaskulär medicin ; Institute of Medicine, Department of Emergeny and Cardiovascular Medicine ; Göteborgs universitet ; Gothenburg University ; Sahlgrenska Academy
descriptionSummary Background 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. We aimed to assess use of proven effective secondary preventive drugs (antiplatelet drugs, β blockers, angiotensin-converting-enzyme [ACE] inhibitors or angiotensin-receptor blockers [ARBs], and statins) in individuals with a history of coronary heart disease or stroke. Methods In the Prospective Urban Rural Epidemiological (PURE) study, we recruited individuals aged 35–70 years from rural and urban communities in countries at various stages of economic development. We 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. We report estimates of drug use at national, community, and individual levels. Findings We 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 [IQR 2·0–10·0]) and 2292 had stroke (4·0 years previously [2·0–8·0]). Overall, few individuals with cardiovascular disease took antiplatelet drugs (25·3%), β blockers (17·4%), ACE inhibitors or ARBs (19·5%), or statins (14·6%). Use was highest in high-income countries (antiplatelet drugs 62·0%, β 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 (ptrend <0·0001 for every drug type). 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, β blockers 23·5% vs 15·6%, ACE inhibitors or ARBs 22·8% vs 15·5%, and statins 19·9% vs 11·6%; all p<0·0001), with greatest variation in poorest countries (pinteraction <0·0001 for urban vs rural differences by country economic status). 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). Interpretation 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. Funding Full funding sources listed at end of paper (see Acknowledgments).
identifier
0ISSN: 0140-6736
1ISSN: 1474-547X
2EISSN: 1474-547X
3DOI: 10.1016/S0140-6736(11)61215-4
4PMID: 21872920
5CODEN: LANCAO
languageeng
publisherKidlington: Elsevier Ltd
subjectAbridged Index Medicus ; Adrenergic beta-Antagonists - therapeutic use ; Adult ; Aged ; Angiotensin-Converting Enzyme Inhibitors - therapeutic use ; Antihypertensive Agents - therapeutic use ; Biological and medical sciences ; Cardiovascular agents ; Cardiovascular Agents - therapeutic use ; Cardiovascular disease ; Cardiovascular diseases ; Cardiovascular Diseases - prevention & control ; Care and treatment ; Community ; Coronary Disease - drug therapy ; Data Collection ; Developed Countries ; Developing Countries ; Drug use ; Drug Utilization ; Economic development ; Epidemiology ; Female ; General aspects ; Health aspects ; Households ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use ; Internal Medicine ; Low income groups ; Male ; MEDICAL AND HEALTH SCIENCES ; Medical sciences ; MEDICIN OCH HÄLSOVETENSKAP ; Middle Aged ; Miscellaneous ; Platelet Aggregation Inhibitors - therapeutic use ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; Rural Population ; Secondary Prevention ; Socioeconomic factors ; Stroke ; Stroke - drug therapy ; Studies ; Urban Population
ispartofThe Lancet (British edition), 2011, Vol.378 (9798), p.1231-1243
rights
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3Copyright © 2011 Elsevier Ltd. All rights reserved.
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5Copyright Elsevier Limited Oct 1-Oct 7, 2011
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0Yusuf, Salim, Prof
1Islam, Shofiqul, MSc
2Chow, Clara K, PhD
3Rangarajan, Sumathy, MSc
4Dagenais, Gilles, Prof
5Diaz, Rafael, MD
6Gupta, Rajeev, PhD
7Kelishadi, Roya, Prof
8Iqbal, Romaina, PhD
9Avezum, Alvaro, MD
10Kruger, Annamarie, Prof
11Kutty, Raman, Prof
12Lanas, Fernando, MD
13Lisheng, Liu, Prof
14Wei, Li, Prof
15Lopez-Jaramillo, Patricio, Prof
16Oguz, Aytekin, MD
17Rahman, Omar, Prof
18Swidan, Hany, MD
19Yusoff, Khalid, Prof
20Zatonski, Witold, Prof
21Rosengren, Annika, Prof
22Teo, Koon K, Prof
23on behalf of the Prospective Urban Rural Epidemiology (PURE) Study Investigators
24Prospective Urban Rural Epidemiology (PURE) Study Investigators
25Sahlgrenska akademin
26Institutionen för medicin, avdelningen för akut och kardiovaskulär medicin
27Institute of Medicine, Department of Emergeny and Cardiovascular Medicine
28Göteborgs universitet
29Gothenburg University
30Sahlgrenska Academy
title
0Use 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
1The Lancet (British edition)
addtitleLancet
descriptionSummary Background 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. We aimed to assess use of proven effective secondary preventive drugs (antiplatelet drugs, β blockers, angiotensin-converting-enzyme [ACE] inhibitors or angiotensin-receptor blockers [ARBs], and statins) in individuals with a history of coronary heart disease or stroke. Methods In the Prospective Urban Rural Epidemiological (PURE) study, we recruited individuals aged 35–70 years from rural and urban communities in countries at various stages of economic development. We 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. We report estimates of drug use at national, community, and individual levels. Findings We 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 [IQR 2·0–10·0]) and 2292 had stroke (4·0 years previously [2·0–8·0]). Overall, few individuals with cardiovascular disease took antiplatelet drugs (25·3%), β blockers (17·4%), ACE inhibitors or ARBs (19·5%), or statins (14·6%). Use was highest in high-income countries (antiplatelet drugs 62·0%, β 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 (ptrend <0·0001 for every drug type). 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, β blockers 23·5% vs 15·6%, ACE inhibitors or ARBs 22·8% vs 15·5%, and statins 19·9% vs 11·6%; all p<0·0001), with greatest variation in poorest countries (pinteraction <0·0001 for urban vs rural differences by country economic status). 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). Interpretation 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. Funding Full funding sources listed at end of paper (see Acknowledgments).
subject
0Abridged Index Medicus
1Adrenergic beta-Antagonists - therapeutic use
2Adult
3Aged
4Angiotensin-Converting Enzyme Inhibitors - therapeutic use
5Antihypertensive Agents - therapeutic use
6Biological and medical sciences
7Cardiovascular agents
8Cardiovascular Agents - therapeutic use
9Cardiovascular disease
10Cardiovascular diseases
11Cardiovascular Diseases - prevention & control
12Care and treatment
13Community
14Coronary Disease - drug therapy
15Data Collection
16Developed Countries
17Developing Countries
18Drug use
19Drug Utilization
20Economic development
21Epidemiology
22Female
23General aspects
24Health aspects
25Households
26Humans
27Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use
28Internal Medicine
29Low income groups
30Male
31MEDICAL AND HEALTH SCIENCES
32Medical sciences
33MEDICIN OCH HÄLSOVETENSKAP
34Middle Aged
35Miscellaneous
36Platelet Aggregation Inhibitors - therapeutic use
37Public health. Hygiene
38Public health. Hygiene-occupational medicine
39Rural Population
40Secondary Prevention
41Socioeconomic factors
42Stroke
43Stroke - drug therapy
44Studies
45Urban Population
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2Chow, Clara K, PhD
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5Diaz, Rafael, MD
6Gupta, Rajeev, PhD
7Kelishadi, Roya, Prof
8Iqbal, Romaina, PhD
9Avezum, Alvaro, MD
10Kruger, Annamarie, Prof
11Kutty, Raman, Prof
12Lanas, Fernando, MD
13Lisheng, Liu, Prof
14Wei, Li, Prof
15Lopez-Jaramillo, Patricio, Prof
16Oguz, Aytekin, MD
17Rahman, Omar, Prof
18Swidan, Hany, MD
19Yusoff, Khalid, Prof
20Zatonski, Witold, Prof
21Rosengren, Annika, Prof
22Teo, Koon K, Prof
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titleUse 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
authorYusuf, Salim, Prof ; Islam, Shofiqul, MSc ; Chow, Clara K, PhD ; Rangarajan, Sumathy, MSc ; Dagenais, Gilles, Prof ; Diaz, Rafael, MD ; Gupta, Rajeev, PhD ; Kelishadi, Roya, Prof ; Iqbal, Romaina, PhD ; Avezum, Alvaro, MD ; Kruger, Annamarie, Prof ; Kutty, Raman, Prof ; Lanas, Fernando, MD ; Lisheng, Liu, Prof ; Wei, Li, Prof ; Lopez-Jaramillo, Patricio, Prof ; Oguz, Aytekin, MD ; Rahman, Omar, Prof ; Swidan, Hany, MD ; Yusoff, Khalid, Prof ; Zatonski, Witold, Prof ; Rosengren, Annika, Prof ; Teo, Koon K, Prof
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topic
0Abridged Index Medicus
1Adrenergic beta-Antagonists - therapeutic use
2Adult
3Aged
4Angiotensin-Converting Enzyme Inhibitors - therapeutic use
5Antihypertensive Agents - therapeutic use
6Biological and medical sciences
7Cardiovascular agents
8Cardiovascular Agents - therapeutic use
9Cardiovascular disease
10Cardiovascular diseases
11Cardiovascular Diseases - prevention & control
12Care and treatment
13Community
14Coronary Disease - drug therapy
15Data Collection
16Developed Countries
17Developing Countries
18Drug use
19Drug Utilization
20Economic development
21Epidemiology
22Female
23General aspects
24Health aspects
25Households
26Humans
27Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use
28Internal Medicine
29Low income groups
30Male
31MEDICAL AND HEALTH SCIENCES
32Medical sciences
33MEDICIN OCH HÄLSOVETENSKAP
34Middle Aged
35Miscellaneous
36Platelet Aggregation Inhibitors - therapeutic use
37Public health. Hygiene
38Public health. Hygiene-occupational medicine
39Rural Population
40Secondary Prevention
41Socioeconomic factors
42Stroke
43Stroke - drug therapy
44Studies
45Urban Population
toplevel
0peer_reviewed
1online_resources
creatorcontrib
0Yusuf, Salim, Prof
1Islam, Shofiqul, MSc
2Chow, Clara K, PhD
3Rangarajan, Sumathy, MSc
4Dagenais, Gilles, Prof
5Diaz, Rafael, MD
6Gupta, Rajeev, PhD
7Kelishadi, Roya, Prof
8Iqbal, Romaina, PhD
9Avezum, Alvaro, MD
10Kruger, Annamarie, Prof
11Kutty, Raman, Prof
12Lanas, Fernando, MD
13Lisheng, Liu, Prof
14Wei, Li, Prof
15Lopez-Jaramillo, Patricio, Prof
16Oguz, Aytekin, MD
17Rahman, Omar, Prof
18Swidan, Hany, MD
19Yusoff, Khalid, Prof
20Zatonski, Witold, Prof
21Rosengren, Annika, Prof
22Teo, Koon K, Prof
23on behalf of the Prospective Urban Rural Epidemiology (PURE) Study Investigators
24Prospective Urban Rural Epidemiology (PURE) Study Investigators
25Sahlgrenska akademin
26Institutionen för medicin, avdelningen för akut och kardiovaskulär medicin
27Institute of Medicine, Department of Emergeny and Cardiovascular Medicine
28Göteborgs universitet
29Gothenburg University
30Sahlgrenska Academy
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jtitleThe Lancet (British edition)
delivery
delcategoryRemote Search Resource
fulltextfulltext
addata
au
0Yusuf, Salim, Prof
1Islam, Shofiqul, MSc
2Chow, Clara K, PhD
3Rangarajan, Sumathy, MSc
4Dagenais, Gilles, Prof
5Diaz, Rafael, MD
6Gupta, Rajeev, PhD
7Kelishadi, Roya, Prof
8Iqbal, Romaina, PhD
9Avezum, Alvaro, MD
10Kruger, Annamarie, Prof
11Kutty, Raman, Prof
12Lanas, Fernando, MD
13Lisheng, Liu, Prof
14Wei, Li, Prof
15Lopez-Jaramillo, Patricio, Prof
16Oguz, Aytekin, MD
17Rahman, Omar, Prof
18Swidan, Hany, MD
19Yusoff, Khalid, Prof
20Zatonski, Witold, Prof
21Rosengren, Annika, Prof
22Teo, Koon K, Prof
aucorp
0on behalf of the Prospective Urban Rural Epidemiology (PURE) Study Investigators
1Prospective Urban Rural Epidemiology (PURE) Study Investigators
2Sahlgrenska akademin
3Institutionen för medicin, avdelningen för akut och kardiovaskulär medicin
4Institute of Medicine, Department of Emergeny and Cardiovascular Medicine
5Göteborgs universitet
6Gothenburg University
7Sahlgrenska Academy
formatjournal
genrearticle
ristypeJOUR
atitleUse 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
jtitleThe Lancet (British edition)
addtitleLancet
date2011
risdate2011
volume378
issue9798
spage1231
epage1243
pages1231-1243
issn
00140-6736
11474-547X
eissn1474-547X
codenLANCAO
abstractSummary Background 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. We aimed to assess use of proven effective secondary preventive drugs (antiplatelet drugs, β blockers, angiotensin-converting-enzyme [ACE] inhibitors or angiotensin-receptor blockers [ARBs], and statins) in individuals with a history of coronary heart disease or stroke. Methods In the Prospective Urban Rural Epidemiological (PURE) study, we recruited individuals aged 35–70 years from rural and urban communities in countries at various stages of economic development. We 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. We report estimates of drug use at national, community, and individual levels. Findings We 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 [IQR 2·0–10·0]) and 2292 had stroke (4·0 years previously [2·0–8·0]). Overall, few individuals with cardiovascular disease took antiplatelet drugs (25·3%), β blockers (17·4%), ACE inhibitors or ARBs (19·5%), or statins (14·6%). Use was highest in high-income countries (antiplatelet drugs 62·0%, β 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 (ptrend <0·0001 for every drug type). 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, β blockers 23·5% vs 15·6%, ACE inhibitors or ARBs 22·8% vs 15·5%, and statins 19·9% vs 11·6%; all p<0·0001), with greatest variation in poorest countries (pinteraction <0·0001 for urban vs rural differences by country economic status). 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). Interpretation 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. Funding Full funding sources listed at end of paper (see Acknowledgments).
copKidlington
pubElsevier Ltd
pmid21872920
doi10.1016/S0140-6736(11)61215-4