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Availability and af...
Availability and affordability of medicines and cardiovascular outcomes in 21 high-income, middle-income and low-income countries.
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Chow, Clara Kayei (author)
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Nguyen, Tu Ngoc (author)
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Marschner, Simone (author)
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Diaz, Rafael (author)
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Rahman, Omar (author)
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Avezum, Alvaro (author)
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Lear, Scott A (author)
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Teo, Koon (author)
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Yeates, Karen E (author)
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Lanas, Fernando (author)
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Li, Wei (author)
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Hu, Bo (author)
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Lopez-Jaramillo, Patricio (author)
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Gupta, Rajeev (author)
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Kumar, Rajesh (author)
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Mony, Prem K (author)
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Bahonar, Ahmad (author)
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Yusoff, Khalid (author)
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Khatib, Rasha (author)
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Kazmi, Khawar (author)
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Dans, Antonio L (author)
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Zatonska, Katarzyna (author)
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Alhabib, Khalid F (author)
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Kruger, Iolanthe Marike (author)
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- Rosengren, Annika, 1951 (author)
- Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för molekylär och klinisk medicin,Institute of Medicine, Department of Molecular and Clinical Medicine
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Gulec, Sadi (author)
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Yusufali, Afzalhussein (author)
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Chifamba, Jephat (author)
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Rangarajan, Sumathy (author)
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McKee, Martin (author)
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Yusuf, Salim (author)
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(creator_code:org_t)
- 2020-11-03
- 2020
- English.
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In: BMJ global health. - : BMJ. - 2059-7908. ; 5:11
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Abstract
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- 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.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.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).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.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
Publication and Content Type
- ref (subject category)
- art (subject category)
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- By the author/editor
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Chow, Clara Kaye ...
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Nguyen, Tu Ngoc
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Marschner, Simon ...
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Diaz, Rafael
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Rahman, Omar
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Avezum, Alvaro
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show more...
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Lear, Scott A
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Teo, Koon
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Yeates, Karen E
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Lanas, Fernando
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Li, Wei
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Hu, Bo
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Lopez-Jaramillo, ...
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Gupta, Rajeev
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Kumar, Rajesh
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Mony, Prem K
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Bahonar, Ahmad
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Yusoff, Khalid
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Khatib, Rasha
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Kazmi, Khawar
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Dans, Antonio L
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Zatonska, Katarz ...
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Alhabib, Khalid ...
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Kruger, Iolanthe ...
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Rosengren, Annik ...
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Gulec, Sadi
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Yusufali, Afzalh ...
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Chifamba, Jephat
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Rangarajan, Suma ...
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McKee, Martin
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Yusuf, Salim
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show less...
- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Cardiac and Card ...
- Articles in the publication
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BMJ global healt ...
- By the university
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University of Gothenburg