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Uptake of secondary CVD prevention measures low worldwide, strategies to reduce mortality outlined
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It is estimated that one-quarter of the 35 million acute coronary or cerebrovascular events that occur worldwide each year are in individuals with previous heart disease or stroke. However, the uptake of secondary prevention measures remain low, especially in low- and middle-income countries. In the World Heart Federation’s goal of achieving a 25% reduction in premature CVD deaths by 2025, improving secondary prevention is a top priority.
“The widespread use of proven secondary prevention interventions is vital to reduce the risk of CVD in those with vascular disease and will be a critical step to reducing CVD premature mortality,” Pablo Perel, MD, PhD, of the World Heart Federation (WHF) and the London School of Hygiene and Tropical Medicine, and colleagues wrote in Global Heart.
Secondary prevention low around the world
The WHF Roadmap for secondary prevention of CVD focuses on gaps in the uptake of secondary prevention using medications and lifestyle changes across high-, middle- and low-income countries. About two-thirds of the disparity in secondary prevention drug use, such as aspirin, ACE inhibitors, beta-blockers and statins, can be attributed to a country’s economic status. Individual-level factors account for only one-third of this difference, according to the authors.
Data from the Population Urban Rural Epidemiology (PURE) study demonstrate that lower-income countries have significantly higher incidence rates of major CVD events and mortality compared with higher-income countries, despite having a lower risk-factor burden. This disparity may be linked to lower rates of preventive care, lower quality management of people with pre-existing CVD and poorer care of acute CV events, according to the authors.
“The use of proven medications in patients with coronary heart disease or stroke is low, particularly in low-income countries, where 80% took no drugs,” Perel and colleagues wrote, citing data from the PURE study. Additional data also indicated low rates of lifestyle change and adherence to diet, physical activity and smoking cessation in patients with previous CVD — notably, in low- and middle-income countries, according to the authors.
However, gaps in secondary prevention of CVD are not limited to lower-income regions. “For example, in the United States and Europe, suboptimal prescription and lifestyle modification rates are reported in patients with established coronary heart disease and stroke,” according to the paper. “These finding suggest that health systems need to be modified to narrow the gaps in secondary prevention.”
Salim Yusuf
WHF ‘roadmap’ for secondary prevention
The authors outline several key components of a secondary prevention plan for patients with CVD, including:
- a strengthened role for primary care providers;
- increased collaboration between health care providers and trained non-physician health care professionals;
- development of simple guidelines for secondary prevention;
- wider use of low-cost, fixed-dose combinations of secondary prevention interventions to increase adherence and simplify treatment options;
- availability of priority interventions at the primary, secondary and community levels;
- promotion of good quality, low-cost, affordable generic options;
- financial and social support for patients;
- use of technology to support physician and non-physician decision-making and to increase patient adherence;
- an information system to monitor progress; and
- accountable governance structures, including national CVD plans.
“This is a global tragedy that can easily be avoided by the actions of governments and can save as many as several million lives every year,” Salim Yusuf, MD, from McMaster University in Hamilton, Ontario, said in a press release. – by Jennifer Byrne
Disclosure: Perel and Yusuf report no relevant financial disclosures.
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