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Proven medical therapies underutilized worldwide

Kathleen Blanchard's picture

An investigation from McMaster University researchers finds common, inexpensive medical therapies are underutilized worldwide.

According to the findings from the PURE (Prospective Urban Rural Epidemiological) study, aspirin, diuretics or fluid pills that can keep blood pressure lower and statin medications aren't being used to prevent heart attack and stroke, despite their low cost, availability and proven benefits.

The study, published in the journal Lancet, “…indicates a large gap in secondary prevention globally, with extremely low rates of use of proven therapies in middle and low income countries,” said Dr. Salim Yusuf, lead author and professor of medicine of McMaster University’s Michael G. DeGroote School of Medicine.”

The study, conducted in 17 countries, also found inexpensive medication therapies aren’t being used in higher income countries including Canada, Sweden and the United Arab Emirates.

Among the 154,000 adults between 35 and 70 years old included in the PURE study, 7500 had a history of heart disease or stroke.

The researchers gathered data to include medication use, education, age, gender and disease risk factors including obesity and smoking.

Yusuf described the finding as “disturbing” and says there is a need to “understand why even inexpensive medications are substantially underutilized worldwide. He adds, “This is a global tragedy and represents a huge wasted opportunity to help millions of people with heart disease at very low cost.”

The scientists aren’t sure about why people aren’t taking medications like aspirin that can reduce the risk of heart disease and stroke.

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Yusuf says there is an “urgent need” to understand why it’s happening. It may be that some fear the side effects of drugs.

A Lancet published study, "Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials" suggested aspirin might be of little benefit for heart attack prevention, citing high risk of bleeding as a concern.

The authors of the study concluded "In primary prevention without previous disease, aspirin is of uncertain net value as the reduction in occlusive events needs to be weighed against any increase in major bleeds. Further trials are in progress."

The benefits of aspirin for those with existing heart disease is well documented. Studies can be confusing to consumers, perhaps contributing to why many people aren't taking drugs that are well studied for disease prevention.

It may be lack of education, transportation, and cost of even generic medicines explaining the gaps in medical therapies that are simple and carry few risks.

The biggest gap was associated with economic versus health status.

The study also found women receive fewer potentially life-saving medications in all settings.

The study identifies a need for more research in understanding why proven, relatively inexpensive medications that can prevent heart attack and stroke in high risk populations are underutilized worldwide. The new study is being presented at the European Society of Cardiology Congress.

The Lancet; doi:10.1016/S0140-6736(11)61215-4
"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"
Salim Yusuf et al.

Image credit: Morguefile