Availability and affordability of cardiovascular disease medicines and their effect on use in high-income, middle-income, and low-income countries: an analysis of the PURE study data

Abstract

17 million people are estimated to die of cardiovascular diseases worldwide every year.1 About 20% occur in those with known vascular disease.2 Many of these deaths could be avoided if the use3 of proven medicines among patients with vascular disease (secondary prevention) were increased. Clinical guidelines recommend the use of four medicines for the secondary prevention of cardiovascular disease: aspirin, β blockers, angiotensin-converting enzyme (ACE) inhibitors or angiotensin-II receptor blockers (ARBs), and statins.4 However, in a previous report from the Prospective Urban Rural Epidemiology (PURE) study, only 25% of patients with established cardiovascular disease were taking aspirin, 17% β blockers, 20% ACE inhibitors or ARBs, and 15% statins. In high-income countries, 11% of eligible patients were not taking any of these medicines, compared with 80% in low-income countries.3