Availability and affordability of medicines and cardiovascular outcomes in 21 high-income, middle-income and low-income countries

Availability and affordability of medicines and cardiovascular outcomes in 21 high-income, middle-income and low-income countries

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 countrie...

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Published in:BMJ Global Health
Main Author: Chow C.K.; Nguyen T.N.; Marschner S.; Diaz R.; Rahman O.; Avezum A.; Lear S.A.; Teo K.; Yeates K.E.; Lanas F.; Li W.; Hu B.; Lopez-Jaramillo P.; Gupta R.; Kumar R.; Mony P.K.; Bahonar A.; Yusoff K.; Khatib R.; Kazmi K.; Dans A.L.; Zatonska K.; Alhabib K.F.; Kruger I.M.; Rosengren A.; Gulec S.; Yusufali A.; Chifamba J.; Rangarajan S.; McKee M.; Yusuf S.
Format: Article
Language:English
Published: BMJ Publishing Group 2020
Online Access:https://www.scopus.com/inward/record.uri?eid=2-s2.0-85095810414&doi=10.1136%2fbmjgh-2020-002640&partnerID=40&md5=8b05c5af854bf9aea745059539a75874
id 2-s2.0-85095810414
spelling 2-s2.0-85095810414
Chow C.K.; Nguyen T.N.; Marschner S.; Diaz R.; Rahman O.; Avezum A.; Lear S.A.; Teo K.; Yeates K.E.; Lanas F.; Li W.; Hu B.; Lopez-Jaramillo P.; Gupta R.; Kumar R.; Mony P.K.; Bahonar A.; Yusoff K.; Khatib R.; Kazmi K.; Dans A.L.; Zatonska K.; Alhabib K.F.; Kruger I.M.; Rosengren A.; Gulec S.; Yusufali A.; Chifamba J.; Rangarajan S.; McKee M.; Yusuf S.
Availability and affordability of medicines and cardiovascular outcomes in 21 high-income, middle-income and low-income countries
2020
BMJ Global Health
5
11
10.1136/bmjgh-2020-002640
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85095810414&doi=10.1136%2fbmjgh-2020-002640&partnerID=40&md5=8b05c5af854bf9aea745059539a75874
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)
BMJ Publishing Group
20597908
English
Article
All Open Access; Gold Open Access
author Chow C.K.; Nguyen T.N.; Marschner S.; Diaz R.; Rahman O.; Avezum A.; Lear S.A.; Teo K.; Yeates K.E.; Lanas F.; Li W.; Hu B.; Lopez-Jaramillo P.; Gupta R.; Kumar R.; Mony P.K.; Bahonar A.; Yusoff K.; Khatib R.; Kazmi K.; Dans A.L.; Zatonska K.; Alhabib K.F.; Kruger I.M.; Rosengren A.; Gulec S.; Yusufali A.; Chifamba J.; Rangarajan S.; McKee M.; Yusuf S.
spellingShingle Chow C.K.; Nguyen T.N.; Marschner S.; Diaz R.; Rahman O.; Avezum A.; Lear S.A.; Teo K.; Yeates K.E.; Lanas F.; Li W.; Hu B.; Lopez-Jaramillo P.; Gupta R.; Kumar R.; Mony P.K.; Bahonar A.; Yusoff K.; Khatib R.; Kazmi K.; Dans A.L.; Zatonska K.; Alhabib K.F.; Kruger I.M.; Rosengren A.; Gulec S.; Yusufali A.; Chifamba J.; Rangarajan S.; McKee M.; Yusuf S.
Availability and affordability of medicines and cardiovascular outcomes in 21 high-income, middle-income and low-income countries
author_facet Chow C.K.; Nguyen T.N.; Marschner S.; Diaz R.; Rahman O.; Avezum A.; Lear S.A.; Teo K.; Yeates K.E.; Lanas F.; Li W.; Hu B.; Lopez-Jaramillo P.; Gupta R.; Kumar R.; Mony P.K.; Bahonar A.; Yusoff K.; Khatib R.; Kazmi K.; Dans A.L.; Zatonska K.; Alhabib K.F.; Kruger I.M.; Rosengren A.; Gulec S.; Yusufali A.; Chifamba J.; Rangarajan S.; McKee M.; Yusuf S.
author_sort Chow C.K.; Nguyen T.N.; Marschner S.; Diaz R.; Rahman O.; Avezum A.; Lear S.A.; Teo K.; Yeates K.E.; Lanas F.; Li W.; Hu B.; Lopez-Jaramillo P.; Gupta R.; Kumar R.; Mony P.K.; Bahonar A.; Yusoff K.; Khatib R.; Kazmi K.; Dans A.L.; Zatonska K.; Alhabib K.F.; Kruger I.M.; Rosengren A.; Gulec S.; Yusufali A.; Chifamba J.; Rangarajan S.; McKee M.; Yusuf S.
title Availability and affordability of medicines and cardiovascular outcomes in 21 high-income, middle-income and low-income countries
title_short Availability and affordability of medicines and cardiovascular outcomes in 21 high-income, middle-income and low-income countries
title_full Availability and affordability of medicines and cardiovascular outcomes in 21 high-income, middle-income and low-income countries
title_fullStr Availability and affordability of medicines and cardiovascular outcomes in 21 high-income, middle-income and low-income countries
title_full_unstemmed Availability and affordability of medicines and cardiovascular outcomes in 21 high-income, middle-income and low-income countries
title_sort Availability and affordability of medicines and cardiovascular outcomes in 21 high-income, middle-income and low-income countries
publishDate 2020
container_title BMJ Global Health
container_volume 5
container_issue 11
doi_str_mv 10.1136/bmjgh-2020-002640
url https://www.scopus.com/inward/record.uri?eid=2-s2.0-85095810414&doi=10.1136%2fbmjgh-2020-002640&partnerID=40&md5=8b05c5af854bf9aea745059539a75874
description 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)
publisher BMJ Publishing Group
issn 20597908
language English
format Article
accesstype All Open Access; Gold Open Access
record_format scopus
collection Scopus
_version_ 1818940560917921792

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