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.