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.

Antecedentes: A pesar de la disponibilidad de terapias basadas en evidencia, no hay información sobre el uso de medicamentos para la prevención secundaria de enfermedades cardiovasculares en entornos comunitarios urbanos y rurales de Sudamérica. Objetivos: Este estudio buscó evaluar el uso y sus predictores de terapias efectivas de prevención secundaria en individuos con antecedentes de enfermedad cardíaca coronaria (EC) o accidente cerebrovascular. Métodos: En el estudio PURE (Prospective Urban Rural Epidemiological), inscribimos a 24,713 individuos de Sudamérica de 35 a 70 años de 97 comunidades rurales y urbanas en Argentina, Brasil, Chile y Colombia. Evaluamos el uso de terapias probadas con cuestionarios estandarizados. Reportamos estimaciones del uso de medicamentos a nivel nacional, comunitario e individual y los predictores independientes de su utilización a través de un modelo de análisis multivariable. Resultados: De 24,713 individuos, 910 tuvieron un evento de EC auto-reportado (con una mediana de 5 años antes) y 407 tuvieron un accidente cerebrovascular (6 años antes). Las proporciones de individuos con cardiopatía coronaria que recibieron medicamentos antiplaquetarios (30,1%), betabloqueantes (34,2%), inhibidores de la enzima convertidora de angiotensina o antagonistas del receptor de angiotensina (36,0%) o estatinas (18,0%) fueron bajas, con proporciones incluso más bajas entre los pacientes con accidente cerebrovascular (antiplaquetarios 24,3%, inhibidores de la enzima convertidora de angiotensina/antagonistas del receptor de angiotensina 37,6%, estatinas 9,8%). Una proporción sustancial de pacientes no recibió ninguna terapia probada (cardiopatía coronaria 31%, accidente cerebrovascular 54%). Una minoría de pacientes recibió las 4 (4,1%) o 3 terapias probadas (3,3%). El sexo masculino, la edad > 60 años, la mejor educación, más riqueza, la ubicación urbana, la diabetes y la obesidad se asociaron con tasas más altas de uso de medicamentos. En un modelo multivariable, los marcadores de riqueza tuvieron el mayor impacto en la prevención secundaria. Conclusiones: Existen importantes deficiencias en el uso de medicamentos de eficacia comprobada para la prevención secundaria de enfermedades cardiovasculares en Sudamérica. Las estrategias para mejorar el uso sostenido de estos medicamentos probablemente reducirán sustancialmente la carga de enfermedades cardiovasculares.

Artículo original

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).

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).

10.1016/j.gheart.2016.06.001

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Cardiac & Cardiovascular Systems

Salud Pública y Ambiental

Servicios y Cuidados en Ciencias de la Salud

Sistema Cardiovascular y Cardiaco

version publicada

dorada

verde

acceso abierto

acceso abierto

WOS:000416934800006

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

Artículo original

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)

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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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