RT Journal Article SR Electronic T1 Availability and affordability of medicines and cardiovascular outcomes in 21 high-income, middle-income and low-income countries JF BMJ Global Health JO BMJ Global Health FD BMJ Publishing Group Ltd SP e002640 DO 10.1136/bmjgh-2020-002640 VO 5 IS 11 A1 Chow, Clara Kayei A1 Nguyen, Tu Ngoc A1 Marschner, Simone A1 Diaz, Rafael A1 Rahman, Omar A1 Avezum, Alvaro A1 Lear, Scott A A1 Teo, Koon A1 Yeates, Karen E A1 Lanas, Fernando A1 Li, Wei A1 Hu, Bo A1 Lopez-Jaramillo, Patricio A1 Gupta, Rajeev A1 Kumar, Rajesh A1 Mony, Prem K A1 Bahonar, Ahmad A1 Yusoff, Khalid A1 Khatib, Rasha A1 Kazmi, Khawar A1 Dans, Antonio L A1 Zatonska, Katarzyna A1 Alhabib, Khalid F A1 Kruger, Iolanthe Marike A1 Rosengren, Annika A1 Gulec, Sadi A1 Yusufali, Afzalhussein A1 Chifamba, Jephat A1 Rangarajan, Sumathy A1 McKee, Martin A1 Yusuf, Salim YR 2020 UL http://gh.bmj.com/content/5/11/e002640.abstract AB 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.