Global Underuse of Cardiovascular Medications Calls for Action

A recent international study highlights significant underuse of vital medications for cardiovascular disease prevention worldwide, pointing to a need for enhanced healthcare strategies.

Significance

This information is crucial as it identifies a large gap in the treatment of CVD, a major global health concern. Addressing these gaps could lead to improved health outcomes and reduced mortality rates.

Quick Summary

The PURE (Prospective Urban Rural Epidemiology) study analyzed medication data from over 11,000 participants with CVD across diverse socio-economic contexts in 17 countries. The study found a persistent underuse of secondary prevention medications, with usage patterns significantly influenced by income levels. Despite the availability of effective and affordable treatment options, the study concluded that current global practices are failing to meet international targets for medication adherence.

Stats and Figures

• 41.3% - Baseline percentage of participants using at least one secondary prevention medication.
• 43.1% - Peak usage percentage among participants during the study period.
• 31.3% - Final study visit percentage of participants using one or more secondary prevention medications.
• 88.8% - Initial medication usage in high-income countries.
• 77.3% - Final medication usage in high-income countries.
• 47.3% - Peak medication usage in low-income countries.
• 27.5% - Final medication usage in low-income countries.

Learning Objectives

Understanding the factors influencing medication adherence and recognizing the need for targeted healthcare policies is essential for improving treatment outcomes in cardiovascular diseases.

Global Trends in Medication Use

The study by Philip Joseph and colleagues highlights a substantial disparity in the use of secondary prevention medications, with marked differences between high, middle, and low-income countries. This disparity suggests that socio-economic factors significantly influence access to and usage of these medications.

"Our findings suggest that current secondary prevention strategies continue to leave the majority of people with CVD either untreated or undertreated," said Dr. Philip Joseph, emphasizing the lack of progress in global medication adherence.

This disparity underscores the need for resource allocation adjustments and policy changes to ensure equitable access to medications essential for CVD management. Despite high awareness of cardiovascular diseases, the lack of medication adherence highlights a gap in healthcare delivery systems, particularly in less affluent regions.

Economic Influence on Medication Adherence

The study's findings indicate that countries with higher incomes generally have better adherence to medication protocols, demonstrating that economic resources are vital for facilitating healthcare access. High-income countries showed a decrease in adherence over time, from 88.8% to 77.3%, potentially reflecting complacency or shifting healthcare priorities.

Conversely, low-income countries saw an increase in adherence, from 20.8% to a peak of 47.3%, suggesting improvements in healthcare infrastructure or increased international aid. Despite these gains, the final adherence percentage dropped to 27.5%, indicating persistent challenges.

These variations imply that economic frameworks influence medication adherence by directly affecting availability, affordability, and healthcare delivery. Addressing these economic barriers could significantly enhance global health outcomes.

Strategies for Improvement

As Harlan M. Krumholz stated, "It is unacceptable that so many individuals worldwide who have already experienced heart disease are not receiving readily available and inexpensive treatments that could save lives and prevent further events." His sentiment reflects a widespread acknowledgment of the need for improved healthcare policies.

Strategies could include increasing healthcare funding, educating healthcare providers on the importance of medication adherence, and fostering international cooperation to standardize treatment protocols across income levels. Policymakers must recognize and address the barriers that prevent optimal medication use.

By targeting these areas, healthcare systems can improve adherence rates, thereby lowering CVD-related morbidity and mortality and moving closer to achieving global health targets.

Citations

Joseph, P., Avezum, Á., Ramasundarahettige, C., Mony, P. K., Yusuf, R., Kazmi, K., Szuba, A., Lopez-Jaramillo, P., Diaz, M. L., Yusufali, A. H., Gulec, S., Kelishadi, R., Wei, L., Chifamba, J., Lanas, F., Puoane, T., Krishnapillai, A., Rangarajan, S., & Yusuf, S. (2025). Secondary Prevention Medications in 17 Countries Grouped by Income Level (PURE): A Prospective Cohort Study. Journal of the American College of Cardiology, 76(3), 523-534. https://doi.org/10.1016/j.jacc.2024.10.121