Global cardiovascular disease incidence could be considerably reduced in a few years if low-cost medications were used more, researchers explained in the medical journal The Lancet and presented at The European Society of Cardiology Congress in Paris, France. The scientists stress that these low-cost life-saving medications are substantially under-used around the world.

The global study revealed that approximately 60% of individuals with heart disease and almost half of patients who suffered a stroke may not be taking any of the four effective drug types - Antiplatelet drugs (mainly aspirin), beta blockers, angiotensin-converting-enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs), and statins.

Under-use is especially common in low-income countries where approximately 80% of patients reported to have received none of these essential drugs that could benefit their treatment.

In an accompanying comment, Anthony Heagerty from The University of Manchester in Manchester, UK explained:

"Even in well developed health-care systems many patients are not receiving the best secondary prevention treatment, despite a wealth of preventative guidelines, continuing medical education, and revalidation programs."

Cardiovascular disease affects more than 100 million people worldwide and irrespective of the fact that approximately 75% of the world's heart disease and stroke burden occur in low- and middle-income countries, these communities have little knowledge about the actual use of preventive drug treatments.

The PURE study was developed to evaluate the use of four key secondary preventive and blood-pressure-lowering drugs in the community in three high-income (Canada, Sweden, United Arab Emirates), ten middle-income (Argentina, Brazil, Chile, Malaysia, Poland, South Africa, Turkey, China, Colombia, and Iran), and four low-income countries (Bangladesh, India, Pakistan, and Zimbabwe).

The study included 153,996 adult participants from five continents who lived in 628 urban and rural communities. 5,650 of them had had a prior coronary heart disease event, while 2,292 had already had a history of stroke.

Preventive drug usage was found to be surprisingly low, overall. Below are some data regarding patients with cardiovascular disease: Just one-quarter took aspirin or some antiplatelet drug 17.4% took beta-blockers 19.5 took ACE inhibitors or ARBs 14.6% took statins High-income countries had the highest use of drugs, with about two thirds of patients taking antiplatelet drugs and statins, and about half of patients receiving beta-blockers and ACE inhibitors or ARBs, compared to the lowest drug use in low-income countries where less than 10% of patients used these proven therapies.

The authors highlight that:

"Even the use of accessible and inexpensive treatments such as aspirin, the most commonly used antiplatelet drug, varied seven-fold between low-income and high-income countries but the use of statins varied 20-fold."

Two-thirds of the impact on variations of drug usage came from how wealthy a country was, the authors explained, while the rest came from such factors as individual's ages, education, smoking-status, whether or not they had hypertension or, diabetes, and sex.

The authors explained:

"Improvements to the uptake of effective secondary prevention strategies are probably more feasible than lifestyle modifications in primary prevention (although both are desirable)...but this will require systematic programs in most countries."

In a comment, Anthony Heagerty wrote:

"In developing countries, the problems are more daunting and complex...Even in areas where cholesterol might be lower than in Europe or North America, the use of statins could reduce stroke and coronary artery disease. Education of doctors and patients must be a priority for governments. Partnership with industry, as employed in the fight against HIV, could reap immediate and valuable rewards where cheap generic drugs are not available."

Petra Rattue