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 Clara Kayei Chow
A1 Tu Ngoc Nguyen
A1 Simone Marschner
A1 Rafael Diaz
A1 Omar Rahman
A1 Alvaro Avezum
A1 Scott A Lear
A1 Koon Teo
A1 Karen E Yeates
A1 Fernando Lanas
A1 Wei Li
A1 Bo Hu
A1 Patricio Lopez-Jaramillo
A1 Rajeev Gupta
A1 Rajesh Kumar
A1 Prem K Mony
A1 Ahmad Bahonar
A1 Khalid Yusoff
A1 Rasha Khatib
A1 Khawar Kazmi
A1 Antonio L Dans
A1 Katarzyna Zatonska
A1 Khalid F Alhabib
A1 Iolanthe Marike Kruger
A1 Annika Rosengren
A1 Sadi Gulec
A1 Afzalhussein Yusufali
A1 Jephat Chifamba
A1 Sumathy Rangarajan
A1 Martin McKee
A1 Salim Yusuf
A1 ,
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.