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Availability and Affordability of Medicines and Cardiovascular Outcomes in 21 High-Income, Middle-Income and Low-Income Countries Publisher



Chow CK1 ; Nguyen TN1 ; Marschner S1 ; Diaz R2 ; Rahman O3 ; Avezum A4 ; Lear SA5 ; Teo K6 ; Yeates KE7 ; Lanas F8 ; Li W9 ; Hu B9 ; Lopezjaramillo P10 ; Gupta R11 Show All Authors
Authors
  1. Chow CK1
  2. Nguyen TN1
  3. Marschner S1
  4. Diaz R2
  5. Rahman O3
  6. Avezum A4
  7. Lear SA5
  8. Teo K6
  9. Yeates KE7
  10. Lanas F8
  11. Li W9
  12. Hu B9
  13. Lopezjaramillo P10
  14. Gupta R11
  15. Kumar R12
  16. Mony PK13
  17. Bahonar A14
  18. Yusoff K15, 16
  19. Khatib R17, 18
  20. Kazmi K19
  21. Dans AL20
  22. Zatonska K21
  23. Alhabib KF22
  24. Kruger IM23
  25. Rosengren A24
  26. Gulec S25
  27. Yusufali A26
  28. Chifamba J27
  29. Rangarajan S6
  30. Mckee M28
  31. Yusuf S6

Source: BMJ Global Health Published:2020


Abstract

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. © 2020 Author(s)
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