A new global analysis reveals a concerning trend in the underutilization of medications for secondary prevention of cardiovascular disease (CVD), with minimal improvements observed over a 12-year period across different economic regions. The findings emerge from the comprehensive Prospective Urban Rural Epidemiology (PURE) study, which examined over 11,000 participants aged 30-70 years with diagnosed CVD across 17 countries.
Global Medication Usage Patterns
The study revealed a troubling decline in medication adherence, with the overall use of at least one class of CVD prevention medication dropping from 41.3% at baseline to 31.3% in the final study visit. This trend was particularly pronounced in certain economic regions, highlighting significant disparities in cardiovascular care access and utilization.
High-income nations, including Canada, Sweden, and the United Arab Emirates, witnessed a notable decrease in medication use from 88.8% to 77.3%. Even more concerning was the sharp decline observed in lower-middle-income countries, where usage plummeted from 29.5% to 13.4% by the study's conclusion.
Economic Disparities in Treatment Access
The research team, led by Dr. Phillip Joseph from the Population Health Research Institute of McMaster University and Hamilton Health Sciences, documented varying patterns across economic strata:
- Upper-middle-income countries showed the only positive trend, with medication use increasing from 55.0% to 61.1%
- Low-income countries experienced fluctuating usage rates, peaking at 47.3% before settling at 27.5%
- The disparity between high and low-income nations remained substantial throughout the study period
Clinical Implications and Expert Perspectives
"It is unacceptable that so many individuals worldwide who have already experienced heart disease are not receiving readily available and inexpensive treatments that could save lives and prevent further events," emphasized Dr. Harlan M. Krumholz, Harold H. Hines Jr. Professor at Yale School of Medicine and Editor-in-Chief of the Journal of the American College of Cardiology.
The findings are particularly significant given that CVD remains the leading cause of death globally, with its prevalence expected to increase in coming decades. Secondary prevention medications play a crucial role in reducing the risk of subsequent cardiovascular events, including death, myocardial infarction, stroke, and heart failure.
Study Methodology and Demographics
The PURE study incorporated a diverse participant pool with a median age of 58 years, with women comprising 52.9% of the cohort. The research tracked medication usage across multiple visits:
- Baseline: 7,409 participants
- Final visit: 11,677 participants
- Study duration: 12 years
- Geographic scope: Urban and rural communities across various income levels
The findings underscore the urgent need for improved strategies to enhance medication access and adherence for secondary CVD prevention, particularly in resource-limited settings. Without significant intervention, global targets for cardiovascular disease management appear increasingly difficult to achieve.
