Secondary Prevention Medications in 17 Countries Grouped by Income Level (PURE)): A Prospective Cohort Study
Authors' conclusion
Globally and in most country income-level groups, the use of medications for secondary CVD prevention has been low, with little improvement over time.
Study context
- Population
- Participants with CVD (CAD or stroke) in 17 high-, middle- and low-income countries7,409 at baseline
- Exposure
- Secondary CVD prevention medication use over time, by country income level
- Outcome
- Use of ≥1 class of secondary CVD prevention medications
- Follow-up
- Baseline and 4 visits (median 12 years)
Methodological detailsmultinational, 17 countries, median follow-up 12 years, Median age at baseline 58.0 years; 52.9% female, Median baseline year 2007; fifth visit 2019
- Multinational
- 17 countries
- Median follow-up 12 years
- Median age at baseline 58.0 years; 52.9% female
- Median baseline year 2007; fifth visit 2019
Main finding
As reported in the abstract
Use of ≥1 class of secondary prevention medications, overall · baseline → peak → last visit
Overall use at baseline
41.3%
95% CI 40.2%–42.4%
Overall peak use
43.1%
95% CI 42.0%–44.1%
Overall use at last visit
31.3%
95% CI 30.4%–32.1%
Observational data: associations, not effects.
Further findings
| Outcome | High-income countries | Upper-middle-income countries | Lower-middle-income countries | Low-income countries | |
|---|---|---|---|---|---|
| Use of ≥1 class of medications, by country income level · baseline → last visit | |||||
| Baseline (95% CI 86.6%-91.0%) | 88.8% | Not reported in the abstract | Not reported in the abstract | Not reported in the abstract | Upper-middle-income countries, Lower-middle-income countries, Low-income countries: not reported in the abstract |
| Last visit (95% CI 74.9%-79.6%) | 77.3% | Not reported in the abstract | Not reported in the abstract | Not reported in the abstract | Upper-middle-income countries, Lower-middle-income countries, Low-income countries: not reported in the abstract |
| Baseline (95% CI 52.8%-57.3%) | Not reported in the abstract | 55.0% | Not reported in the abstract | Not reported in the abstract | High-income countries, Lower-middle-income countries, Low-income countries: not reported in the abstract |
| Last visit (95% CI 59.1%-63.1%) | Not reported in the abstract | 61.1% | Not reported in the abstract | Not reported in the abstract | High-income countries, Lower-middle-income countries, Low-income countries: not reported in the abstract |
| Baseline (95% CI 28.1%-30.9%) | Not reported in the abstract | Not reported in the abstract | 29.5% | Not reported in the abstract | High-income countries, Upper-middle-income countries, Low-income countries: not reported in the abstract |
| Peak (95% CI 30.4%-33.1%) | Not reported in the abstract | Not reported in the abstract | 31.7% | Not reported in the abstract | High-income countries, Upper-middle-income countries, Low-income countries: not reported in the abstract |
| Last visit (95% CI 12.5%-14.2%) | Not reported in the abstract | Not reported in the abstract | 13.4% | Not reported in the abstract | High-income countries, Upper-middle-income countries, Low-income countries: not reported in the abstract |
| Baseline (95% CI 18.1%-23.5%) | Not reported in the abstract | Not reported in the abstract | Not reported in the abstract | 20.8% | High-income countries, Upper-middle-income countries, Lower-middle-income countries: not reported in the abstract |
| Peak (95% CI 44.8%-49.9%) | Not reported in the abstract | Not reported in the abstract | Not reported in the abstract | 47.3% | High-income countries, Upper-middle-income countries, Lower-middle-income countries: not reported in the abstract |
| Last visit (95% CI 25.2%-29.9%) | Not reported in the abstract | Not reported in the abstract | Not reported in the abstract | 27.5% | High-income countries, Upper-middle-income countries, Lower-middle-income countries: not reported in the abstract |
Original publication
Secondary Prevention Medications in 17 Countries Grouped by Income Level (PURE)): A Prospective Cohort Study. J Am Coll Cardiol. Published 11 February 2025. doi:10.
Summarised from the published abstract; every number is checked against it