Key result
Global use of secondary CVD prevention medications declines to ~31% over long-term follow-up.
Why the study?
It was unclear whether the global use of medications for secondary cardiovascular disease prevention is improving over time across countries of different income levels.
Does the use of secondary cardiovascular prevention medications improve over time globally across different country income levels?
Cross-Sectional (n=7,409)
Yes
Does the use of secondary cardiovascular prevention medications improve over time globally across different country income levels?
The global use of secondary cardiovascular prevention medications remains low and has not improved over a 12-year period, highlighting a persistent worldwide gap in guideline-directed medical therapy.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“This landmark study underscores an immense opportunity to improve global cardiovascular health. It is unacceptable that so many individuals worldwide who have already experienced heart disease are not receiving readily available and inexpensive treatments that could save lives and prevent further events. We have the tools to bridge this gap in care now—and we must act urgently.”
“After examining the progress of medication use for secondary cardiovascular (CVD) prevention, our research indicates that there continues to be substantial under-utilization of these medications with little improvement over time, and that global targets are unlikely to be reached.”
“We were expecting something quite different, I would admit. We ended up seeing some mixed changes in different places, but overall the message was that there's been little to no improvement in most places over time.”
Global underuse of secondary CVD prevention meds persists across income levels; leaves open whether targeted strategies can improve uptake.
BACKGROUND: It is unclear whether global use of medications for secondary cardiovascular (CVD) prevention is improving over time. OBJECTIVES: This study across 17 high-, middle- and low-income countries described variations in secondary CVD prevention medication use over a median follow-up of 12 years. METHODS: In the multinational PURE (Prospective Urban Rural Epidemiology) cohort study, we conducted a repeated cross-sectional analysis to examine temporal variations in the use of secondary prevention medications in participants with CVD. In participants with coronary artery disease, we focused on antiplatelet agents, statins, renin-angiotensin system (RAS) inhibitors, and β-blockers. In participants with stroke, we focused on antiplatelet agents, statins, RAS inhibitors, and other blood pressure-lowering drugs. Medications were collected at baseline and on 4 subsequent follow-up visits. RESULTS: The analysis included 7,409 participants with a diagnosis of CVD at the baseline visit, 8,792 at the second visit, 9,236 at the third visit, 11,082 at the fourth visit, and 11,677 at the last visit. The median age at baseline was 58.0 years, and 52.9% of the participants were female. The median follow-up was 12 years, with the median year of the baseline visit in 2007 and the fifth visit in 2019. Over this period, use of 1 or more classes of medications for secondary CVD prevention was 41.3% (95% CI: 40.2%-42.4%) at baseline, peaked at 43.1% (95% CI: 42.0%-44.1%), and then decreased to 31.3% (95% CI: 30.4%-32.1%) by the last study visit. In high-income countries, this use decreased from 88.8% (95% CI: 86.6%-91.0%) to 77.3% (95% CI: 74.9%-79.6%). In upper-middle-income countries, this use increased from 55.0% (95% CI: 52.8%-57.3%) to 61.1% (95% CI: 59.1%-63.1%). In lower-middle-income countries, use of at least 1 class of medications was 29.5% (95% CI: 28.1%-30.9%) at baseline, peaked at 31.7% (95% CI: 30.4%-33.1%), and then decreased to 13.4% (95% CI: 12.5%-14.2%) by the last visit. In low-income countries, use of at least 1 class of medications was 20.8% (95% CI: 18.1%-23.5%) at baseline, peaked at 47.3% (95% CI: 44.8%-49.9%), and then decreased to 27.5% (95% CI: 25.2%-29.9%) by the last study visit. CONCLUSIONS: Globally and in most country income-level groups, the use of medications for secondary CVD prevention has been low, with little improvement over time.
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Joseph et al. (2025) conducted a cross-sectional in Cardiovascular disease (n=7,409). Secondary prevention medications was evaluated on Use of 1 or more classes of medications for secondary CVD prevention. Global use of at least one class of secondary cardiovascular prevention medications was low, starting at 41.3% at baseline and decreasing to 31.3% over a median 12-year follow-up.
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