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- Title
Aspirin for Secondary Prevention of Cardiovascular Disease in 51 Low-, Middle-, and High-Income Countries.
- Authors
Yoo, Sang Gune K.; Chung, Grace S.; Bahendeka, Silver K.; Sibai, Abla M.; Damasceno, Albertino; Farzadfar, Farshad; Rohloff, Peter; Houehanou, Corine; Norov, Bolormaa; Karki, Khem B.; Azangou-Khyavy, Mohammadreza; Marcus, Maja E.; Aryal, Krishna K.; Brant, Luisa C. C.; Theilmann, Michaela; Cífková, Renata; Lunet, Nuno; Gurung, Mongal S.; Mwangi, Joseph Kibachio; Martins, Joao
- Abstract
Key Points: Question: What is the prevalence of aspirin use among people with a history of cardiovascular disease in low-, middle- and high-income countries? Findings: Among individuals with a self-reported history of cardiovascular disease, aspirin use for secondary prevention was 40.3% in the pooled sample and ranged from 16.6% in low-income countries to 65.0% in high-income countries. Meaning: The overall findings suggest suboptimal use of aspirin for secondary prevention of cardiovascular disease in many countries around the world. Importance: Aspirin is an effective and low-cost option for reducing atherosclerotic cardiovascular disease (CVD) events and improving mortality rates among individuals with established CVD. To guide efforts to mitigate the global CVD burden, there is a need to understand current levels of aspirin use for secondary prevention of CVD. Objective: To report and evaluate aspirin use for secondary prevention of CVD across low-, middle-, and high-income countries. Design, Setting, and Participants: Cross-sectional analysis using pooled, individual participant data from nationally representative health surveys conducted between 2013 and 2020 in 51 low-, middle-, and high-income countries. Included surveys contained data on self-reported history of CVD and aspirin use. The sample of participants included nonpregnant adults aged 40 to 69 years. Exposures: Countries' per capita income levels and world region; individuals' socioeconomic demographics. Main Outcomes and Measures: Self-reported use of aspirin for secondary prevention of CVD. Results: The overall pooled sample included 124 505 individuals. The median age was 52 (IQR, 45-59) years, and 50.5% (95% CI, 49.9%-51.1%) were women. A total of 10 589 individuals had a self-reported history of CVD (8.1% [95% CI, 7.6%-8.6%]). Among individuals with a history of CVD, aspirin use for secondary prevention in the overall pooled sample was 40.3% (95% CI, 37.6%-43.0%). By income group, estimates were 16.6% (95% CI, 12.4%-21.9%) in low-income countries, 24.5% (95% CI, 20.8%-28.6%) in lower-middle-income countries, 51.1% (95% CI, 48.2%-54.0%) in upper-middle-income countries, and 65.0% (95% CI, 59.1%-70.4%) in high-income countries. Conclusion and Relevance: Worldwide, aspirin is underused in secondary prevention, particularly in low-income countries. National health policies and health systems must develop, implement, and evaluate strategies to promote aspirin therapy. This cross-sectional study evaluates the prevalence of self-reported aspirin use for secondary prevention of cardiovascular disease (CVD) among individuals in low-, middle-, and high-income countries.
- Subjects
HIGH-income countries; SECONDARY prevention; ASPIRIN; LOW-income countries
- Publication
JAMA: Journal of the American Medical Association, 2023, Vol 330, Issue 8, p715
- ISSN
0098-7484
- Publication type
Article
- DOI
10.1001/jama.2023.12905