Medications for secondary CVD prevention underused worldwide
Key takeaways:
- Many people requiring secondary prevention drugs for CVD do not receive them.
- This trend persisted even in countries considered high income.
- Underuse was even more pronounced in lower-income countries.
Regardless of country-level income classification, medications for the secondary prevention of CVD remains underutilized and patients likely remain undertreated, researcher reported.
Data form the Prospective Urban Rural Epidemiology (PURE) study were published in the Journal of the American College of Cardiology.
“International organizations such as the WHO and U.N. have identified improving the treatment of CVD as a key health target for countries to meet,” Philip Joseph, MD, scientist at the Population Health Research Institute (PHRI) and associate professor of medicine at McMaster University in Hamilton, Ontario, Canada, told Healio. “However, there have been little data outside of the United States and some European countries documenting whether the treatment of individuals with CVD has been improving over the past several years.”
The PURE study involved repeated cross-sectional analysis across four follow-up visits to assess for trends in use of secondary prevention CVD medications during a median follow-up of 12 years across 17 countries.
Participating countries and their corresponding World Bank income classification were as follows:
- Canada, Sweden and United Arab Emirates (high income);
- Argentina, Brazil, Chile, Malaysia, Poland, South Africa and Turkey (upper-middle income);
- China, Colombia and Iran (lower-middle income); and
- Bangladesh, India, Pakistan and Zimbabwe (low income).
At each PURE study follow-up visit, participants were surveyed about their history of CVD and what medication they were specifically taking.
Medications of interest were those used among patients with CAD or stroke, including antiplatelet agents, statins, renin-angiotensin system inhibitors, beta-blockers and other BP-lowering drugs.
“While we did not directly look at the underlying factors contributing to low rates of use of these medications over time, other studies have identified that barriers can exist at the patient, provider and health system levels,” Joseph told Healio. “Several barriers likely impact low- or low-middle-income countries to a greater degree than high-income countries, including the relative affordability of these medications, availability and more limited access to health care providers.”
Trends in secondary prevention medication use
The number of participants with CVD increased over time, with 7,409 participants at baseline and 11,677 by the fourth visit (median age at baseline, 58 years; 53% women).
In high-income countries, use of at least one medication for secondary CVD prevention decreased from 88.8% at baseline (95% CI, 86.6-91) to 77.3% at the fourth follow-up visit (95% CI, 74.9-79.6), according to the study.
The researchers reported increased use of at least one medication for secondary CVD prevention in upper-middle-income countries, with 55% use at baseline (95% CI, 52.8-57.3) and 61.1% at the fourth follow-up (95% CI, 59.1-63.1).
In lower-middle-income countries, use of at least one secondary prevention medication increased from 29.5% at baseline (95% CI, 28.1-30.9), peaked during the interim visits at 31.7% (95% CI, 30.4-33.1) but decreased to 13.4% by the fourth visit (95% CI, 12.5-14.2), according to the study.
Researchers reported 20.8% use of secondary CVD prevention medications in low-income countries at baseline (95% CI, 18.1-23.5), which peaked at 47.3% during the interim visits (95% CI, 44.8-49.9) but decreased to 27.5% by the last study visit (95% CI, 25.2-29.9).
“Our study was primarily a descriptive analysis of the use of these medications over time, but these data indicate that current approaches being taken in secondary CVD prevention are leaving most individuals either untreated or undertreated across groups of countries at different levels of economic development,” Joseph told Healio. “There is a need to consider additional approaches that complement current strategy in order to improve CVD management over time.”
‘Far below the ... intended mark’
In a related editorial, Abhishek Chaturvedi, MD, interventional cardiologist at Georgetown University MedStar Washington Hospital Center and the Center for Chronic Disease Control in New Delhi, and Dorairaj Prabhakaran, MD, also of the Center for Chronic Disease Control, wrote: “We commend the authors for reporting these important yet worrisome data, which show that we are far below the WHO and UN intended mark for secondary CVD prevention,” the authors wrote. “The abrupt decrease in medication use during the final follow-up in most subgroups could be due to the overlap with the [COVID-19] pandemic, illustrating how crises disproportionately impact marginalized groups — a trend consistent with several prior studies. However, the positive initial uptake of medications in India and other low-income countries suggests potential for improvement with appropriate support and strategies.”
For more information:
Philip Joseph, MD, can be reached at 237 Barton St. East, Hamilton, Ontario L8L 2X2, Canada.
References:
- Cardiovascular disease medications underused globally. https://www.eurekalert.org/news-releases/1071961. Published Feb. 3, 2025. Accessed Feb. 3, 2025.
- Chaturvedi A, et al. J Am Coll Cardiol. 2025;doi:10.1016/j.jacc.2024.11.034.
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