August 29th, 2011

Shortfalls in Secondary Prevention Particularly Acute in Poor Countries

It shouldn’t come as a surprise, but an international epidemiological study shows large shortfalls in the use of established drugs for secondary prevention. The shortfalls are dramatically acute in poor countries, said Salim Yusuf, who presented the results of the Prospective Urban Rural Epidemiological (PURE) study at the ESC in Paris on Sunday. The paper was published simultaneously in the Lancet.

The PURE investigators enrolled 153,996 people in 17 countries at different levels of economic development. They identified 5650 people with a history of CHD and 2292 with a history of stroke and ascertained whether these individuals were taking antiplatelet drugs, beta-blockers, ACE inhibitors or ARBs, or statins. Antiplatelet drugs were used by 62% of patients with CVD in high-income countries compared with 8.8% in low-income countries. A similar pattern was observed for beta-blockers (40.0% vs. 9.7%), ACE inhibitors or ARBs (49.8% vs. 5.2%), and statins (66.5% vs. 3.3%).

This study appears to be the first to seek an accurate assessment of the use of drugs for secondary prevention in the community. Previous studies have been hospital based or based on patients who are seeing a physician and who are therefore much more likely to be offered treatment.

The investigators also found that drugs were more likely to be used in urban than in rural areas, though the difference was more pronounced in low-income countries. The economic status of the countries had a bigger effect on drug use than individual factors such as age, sex, education, or other risk factors. Among the study’s many other findings, women and smokers had significantly lower rates of drug use.

The results, said Yusuf, “represent a colossal human tragedy” caused by the “substantial underutilization of proven therapies.” The Lancet authors concluded that “efforts to increase the use of effective and inexpensive drugs for prevention of cardiovascular disease are urgently needed, and would substantially reduce disease burden within a few years.”

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