BACKGROUND: Despite the availability of evidence-based therapies, there is no information on the use of medications for the secondary prevention of cardiovascular disease in urban and rural community settings in South America. OBJECTIVES: This study sought to assess the use, and its predictors, of effective secondary prevention therapies in individuals with a history of coronary heart disease (CHD) or stroke. METHODS: In the PURE (Prospective Urban Rural Epidemiological) study, we enrolled 24,713 individuals from South America ages 35 to 70 years from 97 rural and urban communities in Argentina, Brazil, Chile, and Colombia. We assessed the use of proven therapies with standardized questionnaires. We report estimates of drug use at national, community, and individual levels and the independent predictors of their utilization through a multivariable analysis model. RESULTS: Of 24,713 individuals, 910 had a self-reported CHD event (at a median of 5 years earlier) and 407 had stroke (6 years earlier). The proportions of individuals with CHD who received antiplatelet medications (30.1%), beta-blockers (34.2%), angiotensin-converting enzyme inhibitors, or angiotensin-receptor blockers (36.0%), or statins (18.0%) were low; with even lower proportions among stroke patients (antiplatelets 24.3%, angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers 37.6%, statins 9.8%). A substantial proportion of patients did not receive any proven therapy (CHD 31%, stroke 54%). A minority of patients received either all 4 (4.1%) or 3 proven therapies (3.3%). Male sex, age >60 years, better education, more wealth, urban location, diabetes, and obesity were associated with higher rates of medication use. In a multivariable model, markers of wealth had the largest impact in secondary prevention. CONCLUSIONS: There are large gaps in the use of proven medications for secondary prevention of cardiovascular disease in South America. Strategies to improve the sustained use of these medications will likely reduce cardiovascular disease burden substantially.
BACKGROUND: Despite the availability of evidence-based therapies, there is no information on the use of medications for the secondary prevention of cardiovascular disease in urban and rural community settings in South America. OBJECTIVES: This study sought to assess the use, and its predictors, of effective secondary prevention therapies in individuals with a history of coronary heart disease (CHD) or stroke. METHODS: In the PURE (Prospective Urban Rural Epidemiological) study, we enrolled 24,713 individuals from South America ages 35 to 70 years from 97 rural and urban communities in Argentina, Brazil, Chile, and Colombia. We assessed the use of proven therapies with standardized questionnaires. We report estimates of drug use at national, community, and individual levels and the independent predictors of their utilization through a multivariable analysis model. RESULTS: Of 24,713 individuals, 910 had a self-reported CHD event (at a median of 5 years earlier) and 407 had stroke (6 years earlier). The proportions of individuals with CHD who received antiplatelet medications (30.1%), beta-blockers (34.2%), angiotensin-converting enzyme inhibitors, or angiotensin-receptor blockers (36.0%), or statins (18.0%) were low; with even lower proportions among strokepatients (antiplatelets 24.3%, angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers 37.6%, statins 9.8%). A substantial proportion of patients did not receive any proven therapy (CHD 31%, stroke 54%). A minority of patients received either all 4 (4.1%) or 3 proven therapies (3.3%). Male sex, age >60 years, better education, more wealth, urban location, diabetes, and obesity were associated with higher rates of medication use. In a multivariable model, markers of wealth had the largest impact in secondary prevention. CONCLUSIONS: There are large gaps in the use of proven medications for secondary prevention of cardiovascular disease in South America. Strategies to improve the sustained use of these medications will likely reduce cardiovascular disease burden substantially.
Authors: Gláucia Maria Moraes de Oliveira; Luisa Campos Caldeira Brant; Carisi Anne Polanczyk; Deborah Carvalho Malta; Andreia Biolo; Bruno Ramos Nascimento; Maria de Fatima Marinho de Souza; Andrea Rocha De Lorenzo; Antonio Aurélio de Paiva Fagundes Júnior; Beatriz D Schaan; Fábio Morato de Castilho; Fernando Henpin Yue Cesena; Gabriel Porto Soares; Gesner Francisco Xavier Junior; Jose Augusto Soares Barreto Filho; Luiz Guilherme Passaglia; Marcelo Martins Pinto Filho; M Julia Machline-Carrion; Marcio Sommer Bittencourt; Octavio M Pontes Neto; Paolo Blanco Villela; Renato Azeredo Teixeira; Roney Orismar Sampaio; Thomaz A Gaziano; Pablo Perel; Gregory A Roth; Antonio Luiz Pinho Ribeiro Journal: Arq Bras Cardiol Date: 2022-01 Impact factor: 2.000
Authors: Ricardo Lopez Santi; Felipe Martinez; Adrian Baranchuk; Alvaro Sosa Liprandi; Daniel Piskorz; Alberto Lorenzatti; Maria Pilar Lopez Santi; Juan Carlos Kaski Journal: Eur Cardiol Date: 2021-04-27
Authors: Gláucia Maria Moraes de Oliveira; Luisa Campos Caldeira Brant; Carisi Anne Polanczyk; Andreia Biolo; Bruno Ramos Nascimento; Deborah Carvalho Malta; Maria de Fatima Marinho de Souza; Gabriel Porto Soares; Gesner Francisco Xavier Junior; M Julia Machline-Carrion; Marcio Sommer Bittencourt; Octavio M Pontes Neto; Odilson Marcos Silvestre; Renato Azeredo Teixeira; Roney Orismar Sampaio; Thomaz A Gaziano; Gregory A Roth; Antonio Luiz Pinho Ribeiro Journal: Arq Bras Cardiol Date: 2020-09 Impact factor: 2.667
Authors: Adrianna Murphy; Benjamin Palafox; Owen O'Donnell; David Stuckler; Pablo Perel; Khalid F AlHabib; Alvaro Avezum; Xiulin Bai; Jephat Chifamba; Clara K Chow; Daniel J Corsi; Gilles R Dagenais; Antonio L Dans; Rafael Diaz; Ayse N Erbakan; Noorhassim Ismail; Romaina Iqbal; Roya Kelishadi; Rasha Khatib; Fernando Lanas; Scott A Lear; Wei Li; Jia Liu; Patricio Lopez-Jaramillo; Viswanathan Mohan; Nahed Monsef; Prem K Mony; Thandi Puoane; Sumathy Rangarajan; Annika Rosengren; Aletta E Schutte; Mariz Sintaha; Koon K Teo; Andreas Wielgosz; Karen Yeates; Lu Yin; Khalid Yusoff; Katarzyna Zatońska; Salim Yusuf; Martin McKee Journal: Lancet Glob Health Date: 2018-03 Impact factor: 38.927
Authors: Manuel E Baldeón; Marco Fornasini; Nancy Flores; Philip A Merriam; Milagros Rosal; Juan C Zevallos; Ira Ocken Journal: Rev Panam Salud Publica Date: 2018-09-24
Authors: Paul A Camacho; Diego Gomez-Arbelaez; Johanna Otero; Silvia González-Gómez; Dora I Molina; Gregorio Sanchez; Edgar Arcos; Claudia Narvaez; Henry García; Maritza Pérez; Eric Hernandez-Triana; Myriam Duran; Carlos Cure; Aristides Sotomayor; Alvaro Rico; Fresia Cotes; Sumathy Rangarajan; Salim Yusuf; Patricio López-Jaramillo Journal: Glob Heart Date: 2020-04-21