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Secondary prevention of cardiovascular disease in China
Jiapeng Lu1, Lihua Zhang1, Yuan Lu2
1National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Insights
Secondary prevention drug use for cardiovascular diseases (CVDs) in China is low, with significant variations across different patient groups. Targeted interventions are needed to improve treatment adherence and outcomes for patients with established CVD.
Area of Science:
- Cardiovascular Medicine
- Public Health
- Epidemiology
Background:
- Cardiovascular diseases (CVDs) pose a significant health burden globally and in China.
- Secondary prevention therapies are crucial for managing established CVD and reducing recurrence.
- Understanding current drug utilization patterns is essential for optimizing public health strategies.
Purpose of the Study:
- To estimate the prevalence of secondary prevention drug use (antiplatelet agents and statins) among individuals with established CVD in China.
- To identify individual characteristics associated with the use of these essential medications.
Main Methods:
- Analysis of data from the China Patient-Centered Evaluative Assessment of Cardiac Events Million Persons Project (2014-2018).
- Inclusion of over 2.6 million participants aged 35-75 years from diverse communities across China.
- Utilized multivariable mixed models to assess associations between individual factors and secondary prevention drug use.
Main Results:
- Only 34.2% of individuals with a history of ischemic heart disease or ischemic stroke reported using antiplatelet drugs or statins.
- Significant variations in drug use were observed across different population subgroups (ranging from 8.4% to 60.6%).
- Factors such as younger age, female sex, smoking, alcohol consumption, absence of hypertension/diabetes, and shorter duration of CVD were associated with lower reported drug use.
Conclusions:
- Current use of secondary prevention drugs for CVD in China is suboptimal.
- Substantial disparities in medication use exist across various demographic and clinical subgroups.
- The findings highlight the need for targeted interventions to improve secondary prevention strategies and CVD outcomes in China.
Objective:
We aimed to estimate the current use of secondary prevention drugs and identify its associated individual characteristics among those with established cardiovascular diseases (CVDs) in the communities of China.
Methods:
We studied 2 613 035 participants aged 35-75 years from 8577 communities in 31 provinces in the China Patient-Centered Evaluative Assessment of Cardiac Events Million Persons Project, a government-funded public health programme conducted from 2014 to 2018. Participants self-reported their history of ischaemic heart disease (IHD) or ischaemic stroke (IS) and medication use in an interview. Multivariable mixed models with a logit link function and community-specific random intercepts were fitted to assess the associations of individual characteristics with the reported use of secondary prevention therapies.
Results:
Among 2 613 035 participants, 2.9% (74 830) reported a history of IHD and/or IS, among whom the reported use rate either antiplatelet drugs or statins was 34.2% (31.5% antiplatelet drugs, 11.0% statins and 8.3% both). Among the 1 530 408 population subgroups, which were defined by all possible permutations of 16 individual characteristics, reported use of secondary prevention drugs varied substantially (8.4%-60.6%). In the multivariable analysis, younger people, women, current smokers, current drinkers, people without hypertension or diabetes and those with established CVD for more than 2 years were less likely to report taking antiplatelet drugs or statins.
Conclusions:
The current use of secondary prevention drugs in China is suboptimal and varies substantially across population subgroups. Our study identifies target populations for scalable, tailored interventions to improve secondary prevention of CVD.
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