CVD prevention gaps found
According to the lead author of the the Prospective Urban Rural Epidemiological (PURE) study, Dr Salim Yusuf, Executive Director of the Population Health Research Institute at McMaster University, Canada, there is "a large gap in secondary prevention globally." He added that they "found extremely low rates of use of proven therapies in all countries, but these were more marked in middle and low income countries."
Dr. Yusuf called for efforts to find out why, even if the medicines are inexpensive and readily available, the treatment gap exists. "The data are extremely disturbing, and indicate a need for systematic efforts to understand why even inexpensive medications are substantially under-utilised worldwide. This is a global tragedy and represents a huge wasted opportunity to help millions of people with heart disease at very low cost," he said.The study of 154,00 35 to 70-year-old subjects with a history of heart disease or stroke began in 2002. Data was collected at the national, community and individual levels, covering medication use, age, sex and education, as well as risk factors including diabetes, hypertension, obesity and smoking.
The countries included in the study were Argentina, Bangladesh, Brazil, Canada, Chile, China, Colombia, Iran, India, Malaysia, Pakistan, Poland, South Africa, Sweden, Turkey, UAE and Zimbabwe. The countries were classified as low, llower middle, upper middle or high income.
The study found that between low income and high income countries, the use of aspirin - an inexpensive and readily available drug - varied seven-fold in patients following a heart attack. For the use of statins, the difference was 20-fold. They also found that women used less of the therapies than men.
Dr. Yusuf noted that even in Canada, Sweden and the United Arab Emirates (high-income countries) many post-MI and stroke patients were not taking preventive treatment even if "aspirin, statins and diuretics are of proven benefit... are extremely safe and are very inexpensive."
The full report of the PURE study will be published in the Lancet.
In a related lecture also given at the ESC 2011, epidemiologist Jaakko Tuomilehto discussed how lifestyle measures that are promoted at the population level to prevent type 2 diabetes can also have positive effects for patients of other chronic diseases.
Tuomilehto said, "We know that lifestyle interventions are the most effective means of preventing type 2 diabetes, but it's also clear that these same lifestyle measures have benefits in the prevention of cardiovascular diseases, cancers and Alzheimer's disease." He explained further, "of course, high risk individuals will benefit from medical interventions, but the bigger impact will come at the population level from the prevention of just a few common risk factors."
Top Image Credit: photo of aspirins and a bottle © Scott