medwireNews: Aspirin is underused for the secondary prevention of cardiovascular disease (CVD) on a global scale, particularly in low-income countries, suggest researchers.
San Gune Yoo (Washington University School of Medicine, St Louis, Missouri, USA) and team report that among 124,500 people surveyed from 51 low-, lower-middle-, upper-middle, and high-income countries across the world, “fewer than half of eligible people […] were taking aspirin for secondary prevention of CVD. This fell to “one-quarter in low- and lower-middle-income countries,” they add.
The investigators analyzed individual patient data gathered from nationally representative health surveys conducted between 2013 and 2020; the participants had a median age of 52 years, 50.5% were women, and 53.4% lived in rural areas.
In all, 8.2% of participants had a self-reported history of CVD, including conditions such as myocardial infarction, stroke, or angina. The researchers report in JAMA that only 40.3% of those with a history of CVD reported taking aspirin for secondary prevention.
The percentage varied from 16.6% in low-income countries, such as Afghanistan and Ethiopia, to 65.0% in high-income countries, including the USA and England, they note. Even among lower-middle-income (eg, Kenya and Morocco) and upper-middle-income (eg, Algeria and Ecuador) countries, the rates were just 24.5% and 51.1%, respectively.
Yoo et al say that their findings align with those from the PURE study, which reported varying utilization rates of antiplatelet therapy, including aspirin, at 11.0% in low-income countries, 20.0% in lower-middle-income countries, 27.0% in upper-middle-income countries, and 64.1% in high-income countries.
The findings demonstrate “marked inequities worldwide,” the researchers emphasize, “as illustrated by 4-fold greater aspirin use for secondary CVD prevention in high-income compared with low-income countries.”
They point out: “None of the 30 low income or lower-middle-income countries in our sample achieved the WHO target that at least 50% of eligible individuals with a history of CVD take aspirin,” adding that “[o]nly about half of upper-middle-income and high-income countries […] achieved this target.”
The team concludes: “To meet the goal of reducing premature mortality from [non-communicable diseases], including CVD, national health policies and health systems must develop, implement, and evaluate strategies to promote evidence-based use of aspirin.”