A recent PURE study has found that secondary prevention medications for cardiovascular diseases (CVD), which help prevent further health complications, are underused worldwide, regardless of income level.
Philip Joseph
Led by scientist Philip Joseph, the study observed more than 11,000 participants with diagnosed CVD, aged 30-70, over 12 years. The study, published in JACC, found that the use of these medications remained low with little improvement.
Secondary prevention of CVD focuses on preventing further health problems in people already diagnosed with CVD. This includes managing risk factors through lifestyle changes, medications and treatments. Without intervention, these patients are at a higher risk of death, future heart attacks, strokes and heart failure. Leading international organizations, such as the World Health Organization (WHO) and the United Nations (UN), have issued targets over the last decade to reduce premature mortality from CVD through improved treatments and medications.
“After examining the progress of medication use for secondary cardiovascular (CVD) prevention, our research indicates that there continues to be substantial under-utilization of these medications with little improvement over time, and that global targets are unlikely to be reached,” said Joseph.
The PHRI Prospective Urban Rural Epidemiology (PURE) study, a multi-national, community-based, prospective cohort study. Participants were from communities in countries at different income levels and were selected based on criteria representing urban and rural areas.
Participating countries include: (income level based on their World Bank classification at their time of starting the study)
- High-income: Canada, Sweden, United Arab Emirates
- Upper-middle-income: Argentina, Brazil, Chile, Malaysia, Poland, South Africa, Türkiye
- Lower-middle-income: China, Colombia, Iran
- Low-income: Bangladesh, India, Pakistan, Zimbabwe
Research results showed that medication use for secondary CVD prevention varied by country income level and was lower at the last study visit compared to the first visit in every income level except for upper-middle-income countries.
Overall, the use of at least one medication for secondary prevention started at 41.3% at the baseline study visit, peaked at 43.1%, and dropped to 31.3% at the last study visit. In high-income countries, use declined from 88.8% to 77.3%. In upper-middle-income countries, it rose from 55% to 61.1%. In lower-middle-income countries, it began at 29.5%, peaked at 31.7%, and fell to 13.4%. In low-income countries, it increased from 20.8% to a peak of 47.3%, then declined to 27.5%. Use of three or more proven medication classes for secondary prevention was substantially lower in all country income levels.
“Our findings suggest that current secondary prevention strategies continue to leave the majority of people with CVD either untreated or undertreated,” said Joseph, highlighting “the general lack of progress being made to increase the use of secondary CVD prevention medications in most parts of the world.” The study underscores the pressing need for additional strategies to enhance medication use and CVD management, ultimately reducing premature mortality rates and ensuring better health outcomes globally.
