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Use of Cardiovascular Disease Secondary Prevention Medications in Four Middle East Countries in a Community Setting Publisher Pubmed



Yusufali A1 ; Zidan M2 ; Khatib R3 ; Kelishadi R4 ; Alhabib K5 ; Alshamsi MA2 ; Rais AF2 ; Bintouq AK2 ; Bahonar A4 ; Mohammadifard N4 ; Al Shamiri M5 ; Rangarajan S6 ; Khansaheb H2 ; Yusuf S6
Authors
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Authors Affiliations
  1. 1. Health Improvement Project Zanzibar, Zanzibar, Tanzania
  2. 2. Dubai Health, Dubai, United Arab Emirates
  3. 3. Academic Research and Strategic Partnerships, Advocate Aurora Research Institute (AARI), Milwaukee, United States
  4. 4. Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
  5. 5. College of Medicine, Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia
  6. 6. Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada

Source: Global Heart Published:2024


Abstract

Background: Evidence-based International clinical practice guidelines, universally recommend secondary prevention medications for those with previous cardiovascular disease (CVD). There is limited data on the community use of these medications in the Middle East (ME). Objectives: This study assesses the use and predictors of evidence based secondary prevention medications in individuals with a history of CVD [coronary heart disease (CHD) or stroke]. Methods: Between 2005 and 2015, we enrolled 11,228 individuals aged between 35-70 years from 52 urban and 35 rural communities from four ME countries, United Arab Emirates (n = 1499), Kingdom of Saudi Arabia (n = 2046), Occupied Palestinian Territory (n = 1668) and Islamic Republic of Iran (n = 6013). With standardized questionnaires, we report estimates of medication use in those with CVD at national level and the independent predictors of their utilization through a multivariable analysis model. Results: Of the total ME cohort, 614 (5.5%) had CVD, of which 115 (1.0%) had stroke, 523 (4.7%) had CHD and 24 (0.2%) had both. The mean age of those with CVD was 56.6 ± 8.8 years and 269 (43.8%) were female. Overall, only 23.5% of those with CVD reported using three or more proven secondary prevention medications, and a substantial proportion (stroke 27.8%, CHD 25.8%) did not take any of these medications. In a fully adjusted analysis, increasing age, female gender, higher education, higher wealth in individual household, residence in a higher income country as well as being obese, hypertensive or diabetic were independent predictors of medication use. Conclusion: The use of secondary prevention medication is low in ME and has not reached the modest recommended WHO target of 50% use of 3 or more medications. Independent factors of higher use were, better socioeconomic status (household wealth, country wealth and education) and better contact and accessibility to health care (increasing age, female gender, obesity, diabetes and hypertension). © 2024 Ubiquity Press. All rights reserved.
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