Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
BMJ Glob Health. 2020 Nov;5(11). doi: 10.1136/bmjgh-2020-002640.
We aimed to examine the relationship between access to medicine for cardiovascular disease (CVD) and major adverse cardiovascular events (MACEs) among people at high risk of CVD in high-income countries (HICs), upper and lower middle-income countries (UMICs, LMICs) and low-income countries (LICs) participating in the Prospective Urban Rural Epidemiology (PURE) study.
We defined high CVD risk as the presence of any of the following: hypertension, coronary artery disease, stroke, smoker, diabetes or age >55 years. Availability and affordability of blood pressure lowering drugs, antiplatelets and statins were obtained from pharmacies. Participants were categorised: group 1-all three drug types were available and affordable, group 2-all three drugs were available but not affordable and group 3-all three drugs were not available. We used multivariable Cox proportional hazard models with nested clustering at country and community levels, adjusting for comorbidities, sociodemographic and economic factors.
Of 163 466 participants, there were 93 200 with high CVD risk from 21 countries (mean age 54.7, 49% female). Of these, 44.9% were from group 1, 29.4% from group 2 and 25.7% from group 3. Compared with participants from group 1, the risk of MACEs was higher among participants in group 2 (HR 1.19, 95% CI 1.07 to 1.31), and among participants from group 3 (HR 1.25, 95% CI 1.08 to 1.50).
Lower availability and affordability of essential CVD medicines were associated with higher risk of MACEs and mortality. Improving access to CVD medicines should be a key part of the strategy to lower CVD globally.
我们旨在研究高收入国家（HICs）、中上收入国家（UMICs）、中下收入国家（LMICs）和低收入国家（LICs）中心血管疾病（CVD）高危人群获得治疗 CVD 的药物与主要不良心血管事件（MACEs）之间的关系。该研究纳入 Prospective Urban Rural Epidemiology（PURE）研究的参与者。
我们将高 CVD 风险定义为以下任何一种情况的存在：高血压、冠心病、中风、吸烟者、糖尿病或年龄>55 岁。通过药店获取降压药、抗血小板药和他汀类药物的可及性和可负担性。将参与者分为以下三组：第 1 组——所有三种药物均可得且负担得起；第 2 组——所有三种药物均可获得但负担不起；第 3 组——所有三种药物均不可获得。我们使用多变量 Cox 比例风险模型，对国家和社区层面进行嵌套聚类，同时调整合并症、社会人口统计学和经济因素。
在 21 个国家的 163466 名参与者中，有 93200 名参与者患有 CVD 高危疾病（平均年龄 54.7 岁，49%为女性）。其中，44.9%来自第 1 组，29.4%来自第 2 组，25.7%来自第 3 组。与第 1 组参与者相比，第 2 组参与者的 MACEs 风险更高（HR 1.19，95%CI 1.07 至 1.31），第 3 组参与者的 MACEs 风险更高（HR 1.25，95%CI 1.08 至 1.50）。
治疗 CVD 的基本药物的可及性和可负担性较低与 MACEs 和死亡率风险增加相关。改善 CVD 药物的可及性应该是全球降低 CVD 策略的关键部分。
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