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Availability and Affordability of Medicines and Cardiovascular Outcomes in 21 High-Income, Middle-Income and Low-Income Countries Publisher



Chow CK1 ; Nguyen TN1 ; Marschner S1 ; Diaz R2 ; Rahman O3 ; Avezum A4 ; Lear SA5 ; Teo K6 ; Yeates KE7 ; Lanas F8 ; Li W9 ; Hu B9 ; Lopezjaramillo P10 ; Gupta R11 Show All Authors
Authors
  1. Chow CK1
  2. Nguyen TN1
  3. Marschner S1
  4. Diaz R2
  5. Rahman O3
  6. Avezum A4
  7. Lear SA5
  8. Teo K6
  9. Yeates KE7
  10. Lanas F8
  11. Li W9
  12. Hu B9
  13. Lopezjaramillo P10
  14. Gupta R11
  15. Kumar R12
  16. Mony PK13
  17. Bahonar A14
  18. Yusoff K15, 16
  19. Khatib R17, 18
  20. Kazmi K19
  21. Dans AL20
  22. Zatonska K21
  23. Alhabib KF22
  24. Kruger IM23
  25. Rosengren A24
  26. Gulec S25
  27. Yusufali A26
  28. Chifamba J27
  29. Rangarajan S6
  30. Mckee M28
  31. Yusuf S6
Show Affiliations
Authors Affiliations
  1. 1. Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
  2. 2. Estudios Clinicos Latino America, Rosario, Argentina
  3. 3. Independent University, Dhaka, Dhaka District, Bangladesh
  4. 4. International Research Centre, Hospital Alemao Oswaldo Cruz, Sao Paulo, Brazil
  5. 5. Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
  6. 6. Population Health Research Institute, McMaster University, Hamilton, ON, Canada
  7. 7. Department of Medicine, Queen's University, Kingston, ON, Canada
  8. 8. Universidad de la Frontera, Temuco, Chile
  9. 9. Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Fuwai Hospital, Xicheng District, Beijing, China
  10. 10. Masira Research Institute, Universidad de Santander, Bucaramanga, Colombia
  11. 11. Eternal Heart Care Centre and Research Institute, Jaipur, India
  12. 12. Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
  13. 13. St John's Medical College, Bangalore, Karnataka, India
  14. 14. Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
  15. 15. Faculty of Medicine and Health Sciences, Ucsi University, Kuala Lumpur, Wilayah Persekutuan, Malaysia
  16. 16. Centre for Translational Research and Epidemiology, Faculty of Medicine, University Teknologi Mara, Shah Alam, Selangor, Malaysia
  17. 17. Institute for Community and Public Health, Birzeit University, Birzeit, IL, Palestine
  18. 18. Advocate Research Institute, Advocate Health Care, Hinsdale, IL, United States
  19. 19. Department of Medicine, Aga Khan University, Karachi, Pakistan
  20. 20. Section of Adult Medicine and Medical Research Unit, University of the Philippines, Manila, Philippines
  21. 21. Department of Social Medicine, Wroclaw Medical University, Wroclaw, Poland
  22. 22. Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
  23. 23. Africa Unit for Transdisciplinary Health Research, North-West University, Potchefstroom, South Africa
  24. 24. Department of Molecular and Clinical Medicine, University of Gothenburg and Region Vastra Gotaland, Sahlgrenska University Hospital, Gothenburg, Sweden
  25. 25. Cardiology Department, Ankara University School of Medicine, Ankara, Turkey
  26. 26. Dubai Medical University, Dubai, United Arab Emirates
  27. 27. Physiology Department, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
  28. 28. Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, United Kingdom

Source: BMJ Global Health Published:2020


Abstract

Objectives We aimed to examine the relationship between access to medicine for cardiovascular disease (CVD) and major adverse cardiovascular events (MACEs) among people at high risk of CVD in high-income countries (HICs), upper and lower middle-income countries (UMICs, LMICs) and low-income countries (LICs) participating in the Prospective Urban Rural Epidemiology (PURE) study. Methods We defined high CVD risk as the presence of any of the following: hypertension, coronary artery disease, stroke, smoker, diabetes or age >55 years. Availability and affordability of blood pressure lowering drugs, antiplatelets and statins were obtained from pharmacies. Participants were categorised: group 1-all three drug types were available and affordable, group 2-all three drugs were available but not affordable and group 3-all three drugs were not available. We used multivariable Cox proportional hazard models with nested clustering at country and community levels, adjusting for comorbidities, sociodemographic and economic factors. Results Of 163 466 participants, there were 93 200 with high CVD risk from 21 countries (mean age 54.7, 49% female). Of these, 44.9% were from group 1, 29.4% from group 2 and 25.7% from group 3. Compared with participants from group 1, the risk of MACEs was higher among participants in group 2 (HR 1.19, 95% CI 1.07 to 1.31), and among participants from group 3 (HR 1.25, 95% CI 1.08 to 1.50). Conclusion Lower availability and affordability of essential CVD medicines were associated with higher risk of MACEs and mortality. Improving access to CVD medicines should be a key part of the strategy to lower CVD globally. © 2020 Author(s)
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