Secondary Prevention Medications in 17 Countries Grouped by Income Level (PURE): A Prospective Cohort Study.

Area of Science:

• Cardiovascular Epidemiology
• Global Health
• Pharmacotherapy

Background:

• Uncertainty exists regarding global trends in secondary cardiovascular disease (CVD) prevention medication use over time.
• Assessing temporal variations in medication use is crucial for understanding the effectiveness of secondary CVD prevention strategies worldwide.

Purpose of the Study:

• To describe variations in the use of secondary CVD prevention medications across 17 high-, middle-, and low-income countries over a median follow-up of 12 years.
• To analyze temporal trends in the prescription of antiplatelet agents, statins, renin-angiotensin system (RAS) inhibitors, and beta-blockers for coronary artery disease, and antiplatelet agents, statins, RAS inhibitors, and other blood pressure-lowering drugs for stroke.

Main Methods:

• A repeated cross-sectional analysis was conducted within the multinational Prospective Urban Rural Epidemiology (PURE) cohort study.
• Medication use for secondary CVD prevention was assessed at baseline and four subsequent follow-up visits over a median of 12 years (2007-2019).
• The study included over 7,000 participants with CVD at baseline, with sample sizes increasing across follow-up visits.

Main Results:

• Overall use of at least one class of secondary CVD prevention medication decreased from 41.3% at baseline to 31.3% by the last visit.
• In high-income countries, use declined from 88.8% to 77.3%.
• In upper-middle-income countries, use increased from 55.0% to 61.1%, while lower-middle and low-income countries saw decreases after initial peaks.

Conclusions:

• The global utilization of medications for secondary CVD prevention is low and shows little improvement over time.
• Significant disparities in medication use exist across different country income levels, with high-income countries having the highest, albeit declining, rates.
• Further research and interventions are needed to improve secondary CVD prevention medication use globally, particularly in lower-income settings.