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

Yusuf, S and Islam, Shofiqul and Chow, C K and Rangarajan, Sumathy and Dagenais, G and Diaz, R and Gupta, R and Kelishadi, R and Iqbal, Romaina and Avezum, A and Kruger, A and Kutty, R and Lanas, F and Lisheng, L and Wei, L and Lopez-Jaramillo, Patricio and Oguz, A and Rahman, Omar and Swidan, H and Yusoff, K and Zatonski, W and Rosengren, Annika and Teo, K K (2011) 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. The Lancet, 378 (9798). p. 1231. ISSN 01406736



Background Although most cardiovascular disease occurs in low-income and middle-income countries, little is known about the use of eff ective secondary prevention medications in these communities. We aimed to assess use of proven eff ective 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 eff ective 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 classifi ed 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 diff erences by country economic status). Country-level factors (eg, economic status) aff ected 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 eff ective drugs. Funding Full funding sources listed at end of paper

Item Type:Article
Official URL/DOI:
Uncontrolled Keywords:PURE Study; cardiovascular disease;
Subjects:Diabetology > Cardiovascular Diabetology
Divisions:Department of Epidemiology
Department of Diabetology
Department of Clinical Trials
ID Code:751
Deposited By:surendar radha
Deposited On:16 Oct 2013 12:05
Last Modified:16 Oct 2013 12:05

Repository Staff Only: item control page