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Sep 21, 2011

Why Are Cheap, Proven Preventive Drugs Underused?

Use of aspirin and statins varies greatly among low, middle and high-income countries.

Through extensive cardiovascular research, providers have identified numerous simple and effective drugs that help prevent heart disease and cardiac events in high-risk patients. For example, cholesterol-lowering drugs, known as statins, have been proven to greatly reduce risk for heart attack and death in patients with an elevated risk for heart disease. Aspirin, a simple and widely available drug, can help prevent stroke, heart attack and heart disease in many patients. So why is it that a recent study found that these cheap and effective drugs are being underutilized worldwide?

The PURE study (Prospective Urban Rural Epidemiological), recently presented in Paris at the European Society of Cardiology Congress 2011, reported that the use of treatments such as aspirin and statins varies greatly among low, middle and high-income countries. For example, aspirin and statins were used seven times to twenty times more frequently in patients following a heart attack or stroke in high-income countries than in low-income countries. And the use of these common medications was much less frequent in female patients worldwide than male patients. But underuse of aspirin and statins was not confined to low and middle-income countries only. Patients with a history of heart attack and stroke in the three high-income countries included in the study — Canada, Sweden and the United Arab Emirates — also underutilize these drugs.

There are many possible explanations for the underuse of preventive drugs worldwide. In low- and middle-income countries, cost, even for generic versions of drugs, may limit widespread access.  Among the spectrum of countries included in this study, possible side effects and lack of awareness may also deter patients from adhering to medications long term following a cardiac event.

Regardless of the explanations, researchers see the underuse of preventive drugs as a wasted opportunity to reduce the impact of heart disease worldwide. As the number-one killer of men and women in most countries around the globe, heart disease continues to affect the health of millions of people each year. But improved use of simple, cheap and proven drugs, such as aspirin and statins, could help significantly improve the health of millions suffering from heart disease. Not only is it up to policy makers and healthcare providers to help make these drugs more readily available worldwide, patients must use their medications to achieve desired cardiovascular benefits.  

Questions for You to Consider

  • How many people participated in the PURE study?

  • The PURE study included 154,000 adults between the ages of 35 and 70 with a history of heart disease or stroke, living in 17 high-, middle- and low-income countries.
  • How can the use of preventive drugs, such as aspirin and statins, be increased worldwide?

  • There are a variety of ways that the use of preventive drugs can be increased in high-risk patients. Most importantly, patients must better understand the benefits of these drugs and adhere to their prescriptions. These drugs must also become more readily available in countries where supplies are limited, and access to healthcare must be improved.

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