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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EDespite proven efficacy and relatively low cost, key secondary prevention medications are widely underused in populations with prevalent cardiovascular disease particularly in poor countries and rural areas, according to findings from the Prospective Urban Rural Epidemiological [PURE] study.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EPrevention \u0026amp; Screening\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EDespite proven efficacy and relatively low cost, key secondary prevention medications are widely underused in populations with prevalent cardiovascular disease (CVD), particularly in poor countries and rural areas, according to findings from the Prospective Urban Rural Epidemiological (PURE) study.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EPURE is the first prospective study to evaluate the use of cardiovascular (CV) drugs for secondary prevention across countries with differing levels of economic development. Salim Yusuf, MD, McMaster University, Hamilton, Ontario, Canada, presented results from the PURE study.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EFrom 2003 to 2009, the PURE study enrolled 153,996 adults from 628 urban and rural communities in 17 countries, with a subset of 5650 patients who reported a prior coronary heart disease (CHD) event and 2292 who reported a prior stroke. Participating countries were classified as high-income (Canada, Sweden, and United Arab Emirates), upper-middle-income (Argentina, Brazil, Chile, Malaysia, Poland, South Africa, and Turkey), lower-middle-income (China, Colombia, and Iran), and low-income (Bangladesh, India, Pakistan, and Zimbabwe), based on World Bank criteria at the beginning of the study. Medical history and use of key secondary preventive medications were assessed with a combination of telephone interviews, home visits, and clinic visits.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EAcross all countries, only a minority of patients aged 35 to 70 years with a history of CHD or stroke reported taking key secondary preventive drugs, including antiplatelet drugs, aspirin (25.3%), angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs; 19.5%), \u03b2-blockers (17.4%), or statins (14.6%).\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EBetween-country variations in medication use were twice as large as patient-level variability due to age, sex, education, smoking, obesity, hypertension, and diabetes, suggesting that national policies and health system structures have a predominant role in secondary prevention.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EMedication use was highest in high-income countries and decreased with country income (p-trend \u0026lt;0.0001 for every drug type). Gaps between low-income and high-income countries were approximately 7-fold for aspirin and 20fold for statins. Although 88.8% of patients in high-income countries took at least 1 drug for secondary prevention, far fewer patients received any medication in upper-middle-income countries (54.9%), lower-middle-income countries (30.7%), and low-income countries (19.8%).\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EThere were also differences that were observed between types of communities, with patients in urban areas more likely than those in rural communities to take antiplatelet drugs (28.7% vs 21.3%), \u03b2-blockers (23.5% vs 15.6%), ACE inhibitors or ARBs (22.8% vs 15.5%), and statins (19.9% vs 11.6%), regardless of the economic status of the country (p\u0026lt;0.0001 for all drugs). However, gaps between urban and rural medication use were widest in the poorest counties (p interaction\u0026lt;0.0001).\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EAmong patient-level factors, patients with CVD and hypertension were more likely than those with CVD alone to receive drugs that also lowered blood pressure, including \u03b2-blockers (28% vs 10%) and ACE inhibitors or ARBs (30% vs 5%; \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E). Conversely, younger patients; women; smokers; and those who were less educated, nonobese, or nondiabetic were less likely to use drugs for secondary prevention.\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/10\/16\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Drug Use by History of Hypertension in Participants with CVD.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1887000335\u0022 data-figure-caption=\u0022Drug Use by History of Hypertension in Participants with CVD.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/10\/16\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/10\/16\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/10\/16\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12445\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-10\u0022 class=\u0022first-child\u0022\u003EDrug Use by History of Hypertension in Participants with CVD.\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReproduced with permission from \u003Cem\u003EThe Lancet;\u003C\/em\u003E Use of secondary prevention drugs for cardiovascular disease in the community in high-income, middle-income, and low-income countries (the PURE Study): a prospective epidemiological survey; Yusuf S et al. 2011.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-11\u0022\u003ELong-term follow-up of the PURE study is ongoing. Future reports from the PURE trial will examine specific barriers to effective health care delivery, with the intention of shaping national policies to increase access to medications that are vital for the secondary prevention of CVD.\u003C\/p\u003E\u003Cp id=\u0022p-12\u0022\u003EThe results of this large global study underscore the importance of efforts to increase the use of proven secondary preventive therapies and offer an opportunity to reduce CV morbidity and mortality using proven, available, and inexpensive therapies. While the greatest need appears to be in lower-income countries, there appears to be significant underuse in high-income countries as well. These data support the concept of a \u201cpolypill,\u201d which has the potential to deliver multiple proven therapies in a single pill in an attempt to close the large treatment gap that was observed in this analysis. The appeal of such an approach is the simplicity that it offers to deliver several drugs at once, which may outweigh the limited flexibility in the selection of the specific drugs and their doses.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2011 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section ref-list\u0022 id=\u0022ref-list-1\u0022\u003E\u003Ch2 class=\u0022\u0022\u003EAdditional Reading\u003C\/h2\u003E\u003Col class=\u0022cit-list ref-use-labels\u0022\u003E\u003Cli\u003E\u003Cspan class=\u0022ref-label ref-label-empty\u0022\u003E\u003C\/span\u003E\n            \u003Cdiv class=\u0022cit ref-cit ref-journal no-rev-xref\u0022 id=\u0022cit-11.10.16.1\u0022\u003E\u003Cdiv class=\u0022cit-metadata\u0022\u003E\u003Col class=\u0022cit-auth-list\u0022\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EYusuf\u003C\/span\u003E  \u003Cspan class=\u0022cit-name-given-names\u0022\u003ES\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-etal\u0022\u003Eet al\u003C\/span\u003E\u003C\/li\u003E\u003C\/ol\u003E\u003Ccite\u003E. \u003Cabbr class=\u0022cit-jnl-abbrev\u0022\u003ELancet\u003C\/abbr\u003E \n               \u003Cspan class=\u0022cit-pub-date\u0022\u003E2011\u003C\/span\u003E.\u003C\/cite\u003E\u003C\/div\u003E\u003Cdiv class=\u0022cit-extra\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003C\/li\u003E\u003C\/ol\u003E\u003C\/div\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/11\/10\/16.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzmyrp\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmyrp\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}