A global study reveals that inexpensive drug treatments for cardiovascular disease that have been proven to save lives are substantially underused worldwide. Around 60% of individuals with heart disease and up to half of patients who have had a stroke might not be taking any of the four effective drug types*. Underuse of these beneficial treatments is especially common in low-income countries where about 80% of patients reported receiving none of these essential drugs.
The largest study of its kind to date, presented at The European Society of Cardiology Congress in Paris, France, and published simultaneously Online First in The Lancet, suggests that improvements in the use of these low-cost drugs could substantially reduce global cardiovascular disease within just a few years.
"Even in well developed health-care systems many patients are not receiving the best secondary prevention treatment, despite a wealth of preventative guidelines, continuing medical education, and revalidation programmes", explains Anthony Heagerty from The University of Manchester, Manchester, UK in an accompanying Comment.
Globally, cardiovascular disease affects more than 100 million people. Despite around 75% of the world's heart disease and stroke burden occurring in low-income and middle-income countries, little is known about the actual use of preventive drug treatments in these communities.
The PURE study was designed to assess the use of four key secondary preventive and blood-pressure-lowering drugs in the community in three high-income, ten middle-income, and four low-income countries**. The study enrolled 153 996 adults from 628 rural and urban communities across five continents. 5650 participants reported a prior coronary heart disease event and 2292 a previous stroke.
Overall, the use of preventive drugs was low. Antiplatelet drugs (mainly aspirin) were taken by only a quarter of individuals with cardiovascular disease, ß-blockers by 17.4%, ACE inhibitors or ARBs by 19.5%, and statins by just 14.6%.
Drug use was highest in high income countries (where about two thirds of patients were taking antiplatelet drugs and statins, and about half of patients ß-blockers and ACE inhibitors or ARBs) and lowest in low-income countries (where less than 10% of patients used these proven therapies).
The authors point out: "Even the use of accessible and inexpensive treatments such as aspirin (the most commonly used antiplatelet drug) varied seven-fold between low-income and high-income countries but the use of statins varied 20-fold."
The economic wealth of a country accounted for two thirds of the variation in drug use, with individual-related factors (such as age, sex, education, smoking, hypertension, and diabetes) affecting the rest.
According to the authors: "Improvements to the uptake of effective secondary prevention strategies are probably more feasible than lifestyle modifications in primary prevention (although both are desirable)…but this will require systematic programmes in most countries."
In a Comment, Anthony Heagerty says: "In developing countries, the problems are more daunting and complex…Even in areas where cholesterol might be lower than in Europe or North America, the use of statins could reduce stroke and coronary artery disease. Education of doctors and patients must be a priority for governments. Partnership with industry, as employed in the fight against HIV, could reap immediate and valuable rewards where cheap generic drugs are not available."
Professor Salim Yusuf, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada. Via Veronica McGuire, Media Relations, Faculty of Health Sciences, McMaster University T) +1 905 525 9140 Ext 22169 E) vmcguir@mcmaster.ca
Dr Anthony Heagerty, University of Manchester, Manchester, UK. T) +44 (0)161 275 1199 E) tony.heagerty@manchester.ac.uk
Notes to Editors: *Antiplatelet drugs (mainly aspirin), ß blockers, angiotensin-converting-enzyme [ACE] inhibitors or angiotensin-receptor blockers [ARBs], and statins.
** Three high-income countries (Canada, Sweden, United Arab Emirates), ten middle-income countries (Argentina, Brazil, Chile, Malaysia, Poland, South Africa, Turkey, China, Colombia, and Iran), and four low-income countries (Bangladesh, India, Pakistan, and Zimbabwe).
Journal
The Lancet