What is the prevalence of aspirin use among people with a history of cardiovascular disease in low-, middle- and high-income countries?
Among individuals with a self-reported history of cardiovascular disease, aspirin use for secondary prevention was 40.3% in the pooled sample and ranged from 16.6% in low-income countries to 65.0% in high-income countries.
The overall findings suggest suboptimal use of aspirin for secondary prevention of cardiovascular disease in many countries around the world.
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.
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.
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.
The overall pooled sample included 124 505 individuals. The median age was 52 (IQR, 45-59) years, and 50.5% (95% CI, 49.9%-51.1%) were women. A total of 10 589 individuals had a self-reported history of CVD (8.2% [95% CI, 7.7%-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.
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Corresponding Author: Sang Gune K. Yoo, MD, Cardiovascular Division, John T. Milliken Department of Internal Medicine, Washington University School of Medicine, 660 S Euclid Ave, MSC 8086-43-13, St Louis, MO 63100 (email@example.com).
Accepted for Publication: June 26, 2023.
Correction: This article was corrected on September 1, 2023, to fix a data error in the abstract.
Author Contributions: Dr Flood had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Yoo, Bolormaa, Vollmer, Bärnighausen, Singh, Guwatudde, Geldsetzer, Flood.
Acquisition, analysis, or interpretation of data: Yoo, Chung, Bahendeka, Sibai, Damasceno, Farzadfar, Rohloff, Houehanou, Bolormaa, Karki, Azangou-Khyavy, Marcus, Aryal, Brant, Theilmann, Cífková, Lunet, Gurung, Mwangi, Martins, Haghshenas, Sturua, Vollmer, Atun, Sussman, Singh, Saeedi Moghaddam, Geldsetzer, Manne-Goehler, Huffman, Davies, Flood.
Drafting of the manuscript: Yoo, Davies, Flood.
Statistical analysis: Bärnighausen, Flood.
Obtained funding: Mwangi, Guwatudde, Flood.
Administrative, technical, or material support: Bahendeka, Farzadfar, Bolormaa, Karki, Marcus, Aryal, Brant, Theilmann, Lunet, Gurung, Mwangi, Martins, Haghshenas, Sussman, Singh, Saeedi Moghaddam, Guwatudde, Manne-Goehler, Flood.
Supervision: Rohloff, Cífková, Bärnighausen, Singh, Guwatudde, Davies, Flood.
Conflict of Interest Disclosures: Dr Atun reported consulting and speaking engagements for Novartis and F. Hoffmann-La Roche unrelated to the study or the subject. Dr Manne-Goehler reported undertaking COVID-19 clinical trials for Regeneron Pharmaceuticals. Dr Huffman reported that his employer, The George Institute for Global Health, has a patent and license, and has received investment funding with intent to commercialize fixed-dose combination therapy through its social enterprise business, George Medicines; Dr Huffman also reported travel support from the World Heart Federation and having a patent pending for heart failure polypills. Dr Flood reported serving as a volunteer physician for the Guatemala-based nongovernmental organization Maya Health Alliance. No other disclosures were reported.
Funding/Support: Dr Flood was supported by the US National Heart, Lung, and Blood Institute (award K23HL161271), the Michigan Center for Diabetes Translational Research (award P30DK092926), the University of Michigan Claude D. Pepper Older Americans Independence Center (award 5P30AG024824), and the University of Michigan Caswell Diabetes Institute Clinical Translational Research Scholars Program.
Role of the Funder/Sponsor: The study supporters had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.
Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the US National Institutes of Health.
Data Sharing Statement: See Supplement 2.
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