TY - JOUR
T1 - Aspirin for Secondary Prevention of Cardiovascular Disease in 51 Low-, Middle-, and High-Income Countries
AU - Yoo, Sang Gune K.
AU - Chung, Grace S.
AU - Bahendeka, Silver K.
AU - Sibai, Abla M.
AU - Damasceno, Albertino
AU - Farzadfar, Farshad
AU - Rohloff, Peter
AU - Houehanou, Corine
AU - Norov, Bolormaa
AU - Karki, Khem B.
AU - Azangou-Khyavy, Mohammadreza
AU - Marcus, Maja E.
AU - Aryal, Krishna K.
AU - Brant, Luisa C.C.
AU - Theilmann, Michaela
AU - Cífková, Renata
AU - Lunet, Nuno
AU - Gurung, Mongal S.
AU - Mwangi, Joseph Kibachio
AU - Martins, Joao
AU - Haghshenas, Rosa
AU - Sturua, Lela
AU - Vollmer, Sebastian
AU - Bärnighausen, Till
AU - Atun, Rifat
AU - Sussman, Jeremy B.
AU - Singh, Kavita
AU - Saeedi Moghaddam, Sahar
AU - Guwatudde, David
AU - Geldsetzer, Pascal
AU - Manne-Goehler, Jennifer
AU - Huffman, Mark D.
AU - Davies, Justine I.
AU - Flood, David
N1 - Publisher Copyright:
© 2023 American Medical Association. All rights reserved.
PY - 2023/8/22
Y1 - 2023/8/22
N2 - 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 124505 individuals. The median age was 52 (IQR, 45-59) years, and 50.5% (95% CI, 49.9%-51.1%) were women. A total of 10589 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..
AB - 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 124505 individuals. The median age was 52 (IQR, 45-59) years, and 50.5% (95% CI, 49.9%-51.1%) were women. A total of 10589 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..
UR - http://www.scopus.com/inward/record.url?scp=85168485928&partnerID=8YFLogxK
U2 - 10.1001/jama.2023.12905
DO - 10.1001/jama.2023.12905
M3 - Article
C2 - 37606674
AN - SCOPUS:85168485928
SN - 0098-7484
VL - 330
SP - 715
EP - 724
JO - JAMA
JF - JAMA
IS - 8
ER -