Nature Medicine | Spoonful of Medicine

Essential heart drugs remain badly underused, particularly in poor countries

Over the past two decades, drug therapies have done wonders to improve the survival and quality of life for people living with heart disease and stroke. Antiplatelets, such as aspirin, decrease blood clots; beta blockers, angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) reduce blood pressure; and statins curb ‘bad’ cholesterol levels. Despite these benefits, however, these drugs go underused, particularly in low-income countries, according to a study published yesterday in The Lancet.

“Strong action is needed,” Tony Heagerty, who studies cardiovascular medicine at the UK’s University of Manchester, wrote in an accompanying commentary. “An epidemic of cardiovascular disease is just beginning in many countries that are ill prepared for what is to come.”

The study, led by Salim Yusuf of McMaster University in Hamilton, Ontario, recruited more than 150,000 people from 17 countries who self-reported their medical histories and drug use. Of the 7,500 people who had coronary heart disease or a stroke, only 25% took antiplatelets, 17% took beta blockers, nearly 20% took ACE inhibitors or ARBs, and fewer than 15% took statins. In addition to the new report, Yusuf’s team also presented the findings over the weekend at the European Society of Cardiology Congress in Paris.

The rates of drug use were far lower in poorer countries, the researchers found. For example, someone suffering from heart attack or stroke in India is seven times less likely to receive aspirin and 20 times less likely to be on statins than an average Canadian, the Times of India reports. Other groups with particularly low drug use were women, younger people, rural populations, current smokers and the non-obese.

“Even in well developed health-care systems many patients are not receiving the best secondary prevention treatment,” wrote Heagerty. “The message is clear: the strategy needs a fresh look and reinforcement.”

Comments

There are currently no comments.