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Secondary CV Prevention in South America in a Community Setting: The PURE Study

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dc.contributor.author Avezum, Alvaro
dc.contributor.author Oliveira, Gustavo B. F.
dc.contributor.author Lanas, Fernando
dc.contributor.author Lopez-Jaramillo, Patricio
dc.contributor.author Diaz, Rafael
dc.contributor.author Miranda, J. Jaime
dc.contributor.author Seron, Pamela
dc.contributor.author Camacho-Lopez, Paul A.
dc.contributor.author Orlandini, Andres
dc.contributor.author Bernabé Ortiz, Antonio
dc.contributor.author Cordeiro Mattos, Antonio
dc.contributor.author Islam, Shofiqul
dc.contributor.author Rangarajan, Sumathy
dc.contributor.author Teo, Koon
dc.contributor.author Yusuf, Salim
dc.date.accessioned 2019-01-25T16:03:20Z
dc.date.available 2019-01-25T16:03:20Z
dc.date.issued 2017
dc.identifier.uri https://hdl.handle.net/20.500.12866/4752
dc.description.abstract BACKGROUND: Despite the availability of evidence-based therapies, there is no information on the use of medications for the secondary prevention of cardiovascular disease in urban and rural community settings in South America. OBJECTIVES: This study sought to assess the use, and its predictors, of effective secondary prevention therapies in individuals with a history of coronary heart disease (CHD) or stroke. METHODS: In the PURE (Prospective Urban Rural Epidemiological) study, we enrolled 24,713 individuals from South America ages 35 to 70 years from 97 rural and urban communities in Argentina, Brazil, Chile, and Colombia. We assessed the use of proven therapies with standardized questionnaires. We report estimates of drug use at national, community, and individual levels and the independent predictors of their utilization through a multivariable analysis model. RESULTS: Of 24,713 individuals, 910 had a self-reported CHD event (at a median of 5 years earlier) and 407 had stroke (6 years earlier). The proportions of individuals with CHD who received antiplatelet medications (30.1%), beta-blockers (34.2%), angiotensin-converting enzyme inhibitors, or angiotensin-receptor blockers (36.0%), or statins (18.0%) were low; with even lower proportions among stroke patients (antiplatelets 24.3%, angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers 37.6%, statins 9.8%). A substantial proportion of patients did not receive any proven therapy (CHD 31%, stroke 54%). A minority of patients received either all 4 (4.1%) or 3 proven therapies (3.3%). Male sex, age >60 years, better education, more wealth, urban location, diabetes, and obesity were associated with higher rates of medication use. In a multivariable model, markers of wealth had the largest impact in secondary prevention. CONCLUSIONS: There are large gaps in the use of proven medications for secondary prevention of cardiovascular disease in South America. Strategies to improve the sustained use of these medications will likely reduce cardiovascular disease burden substantially. en_US
dc.language.iso eng
dc.publisher Elsevier
dc.relation.ispartofseries Global Heart
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Adult en_US
dc.subject Female en_US
dc.subject Humans en_US
dc.subject Male en_US
dc.subject Aged en_US
dc.subject Middle Aged en_US
dc.subject Prospective Studies en_US
dc.subject Age Distribution en_US
dc.subject Sex Distribution en_US
dc.subject Rural Population en_US
dc.subject South America/epidemiology en_US
dc.subject Developing Countries en_US
dc.subject Morbidity/trends en_US
dc.subject Urban Population en_US
dc.subject Cardiovascular Agents/therapeutic use en_US
dc.subject Cardiovascular Diseases/epidemiology/prevention & control en_US
dc.subject Secondary Prevention/methods en_US
dc.title Secondary CV Prevention in South America in a Community Setting: The PURE Study en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1016/j.gheart.2016.06.001
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.04
dc.relation.issn 2211-8179


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