Repositorio
Institucional

Avezum, Alvaro

Oliveira, Gustavo B. F.#Lanas, Fernando#Lopez-Jaramillo, Patricio#Diaz, Rafael#Jaime Miranda, J.#Seron, Pamela#Camacho-Lopez, Paul A.#Orlandini, Andres#Bernabe-Ortiz, Antonio#Mattos, Antonio Cordeiro#Islam, Shofiqul#Rangarajan, Sumathy#Teo, Koon#Yusuf, Salim

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

UBIQUITY PRESS LTD

GLOBAL HEART

en

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.

Artículo original

The main PURE study and its components are funded by the Population Health Research Institute, the Canadian Institutes of Health Research, and the Heart and Stroke Foundation of Ontario, and through unrestricted grants from several pharmaceutical companies (with major contributions from Boehringer Ingelheim [Germany and Canada], AstraZeneca [Canada], Sanofi-Aventis [France and Canada], Servier, and GlaxoSmithKline, with additional contributions from Novartis and King Pharma), and various national or local organizations in participating countries as follows: Fundacion Estudios Clinicos Latinamerica (ECLA) (Argentina), Unilever Health Institute (Brazil), Public Health Agency of Canada and Champlain Cardiovascular Disease Prevention Network (Canada), Universidad de la Frontera (Chile), grant from Colciencias (6566-04-18062) (Colombia).

El estudio principal PURE y sus componentes son financiados por el Population Health Research Institute, los Canadian Institutes of Health Research y la Heart and Stroke Foundation de Ontario, y a través de subvenciones sin restricciones de varias compañías farmacéuticas (con importantes contribuciones de Boehringer Ingelheim [Alemania y Canadá], AstraZeneca [Canadá], Sanofi-Aventis [Francia y Canadá], Servier y GlaxoSmithKline, con contribuciones adicionales de Novartis y King Pharma), y varias organizaciones nacionales o locales en los países participantes de la siguiente manera: Fundación Estudios Clínicos Latinoamericanos (ECLA) (Argentina), Unilever Health Institute (Brasil), Public Health Agency of Canada y Champlain Cardiovascular Disease Prevention Network (Canadá), Universidad de la Frontera (Chile), subvención de Colciencias (6566-04-18062) (Colombia).

10.1016/j.gheart.2016.06.001

pdf

http://dx.doi.org/10.1016/j.gheart.2016.06.001

Cardiac & Cardiovascular Systems

Salud Pública y Ambiental

Servicios y Cuidados en Ciencias de la Salud

Sistema Cardiovascular y Cardiaco

WOS:000416934800006

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

Artículo original

version publicada

UBIQUITY PRESS LTD

GLOBAL HEART

Sistemas cardíacos y cardiovasculares

2211-8160

en

Population Health Research Institute#Canadian Institutes of Health Research#Heart and Stroke#Boehringer Ingelheim [Germany and Canada]#AstraZeneca [Canada]#Sanofi-Aventis [France and Canada]#Servier#GlaxoSmithKline#Novartis and King Pharma#Fundacion Estudios Clinicos Latinamerica (ECLA)#Unilever Health Institute (Brazil)#Public Health Agency of Canada#Champlain Cardiovascular Disease Prevention Network (Canada)#UFRO#Colciencias 6566-04-18062

Population Health Research Institute

Canadian Institutes of Health Research

Heart and Stroke

Boehringer Ingelheim (Germany)

Boehringer Ingelheim (Canada)

AstraZeneca (Canada)

Sanofi-Aventis (France)

Sanofi-Aventis (Canada)

Servier

GlaxoSmithKline

Novartis

King Pharma

Fundacion Estudios Clinicos Latinamerica (ECLA) (Argentina)

Unilever Health Institute (Brazil)

Public Health Agency of Canada

Champlain Cardiovascular Disease Prevention Network (Canada)

UFRO

Colciencias 6566-04-18062

The main PURE study and its components are funded by the Population Health Research Institute, the Canadian Institutes of Health Research, and the Heart and Stroke Foundation of Ontario, and through unrestricted grants from several pharmaceutical companies (with major contributions from Boehringer Ingelheim [Germany and Canada], AstraZeneca [Canada], Sanofi-Aventis [France and Canada], Servier, and GlaxoSmithKline, with additional contributions from Novartis and King Pharma), and various national or local organizations in participating countries as follows: Fundacion Estudios Clinicos Latinamerica (ECLA) (Argentina), Unilever Health Institute (Brazil), Public Health Agency of Canada and Champlain Cardiovascular Disease Prevention Network (Canada), Universidad de la Frontera (Chile), grant from Colciencias (6566-04-18062) (Colombia).

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