Use of Cardiovascular Disease Secondary Prevention Medications in Four Middle East Countries in a Community Setting.

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Global Heart Pub Date : 2024-08-26 eCollection Date: 2024-01-01 DOI:10.5334/gh.1349

Afzalhussein Yusufali, Marwan Zidan, Rasha Khatib, Roya Kelishadi, Khalid Alhabib, Mariam Alnoman Alshamsi, Ahmad Farid Rais, Afra Khalid Bintouq, Ahmad Bahonar, Noushin Mohammadifard, Mostafa Al Shamiri, Sumathy Rangarajan, Hamda Khansaheb, Salim Yusuf

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Abstract

Background: Evidence-based International clinical practice guidelines, universally recommend secondary prevention medications for those with previous cardiovascular disease (CVD). There is limited data on the community use of these medications in the Middle East (ME).

Objectives: This study assesses the use and predictors of evidence based secondary prevention medications in individuals with a history of CVD [coronary heart disease (CHD) or stroke].

Methods: Between 2005 and 2015, we enrolled 11,228 individuals aged between 35-70 years from 52 urban and 35 rural communities from four ME countries, United Arab Emirates (n = 1499), Kingdom of Saudi Arabia (n = 2046), Occupied Palestinian Territory (n = 1668) and Islamic Republic of Iran (n = 6013). With standardized questionnaires, we report estimates of medication use in those with CVD at national level and the independent predictors of their utilization through a multivariable analysis model. Results: Of the total ME cohort, 614 (5.5%) had CVD, of which 115 (1.0%) had stroke, 523 (4.7%) had CHD and 24 (0.2%) had both. The mean age of those with CVD was 56.6 ± 8.8 years and 269 (43.8%) were female. Overall, only 23.5% of those with CVD reported using three or more proven secondary prevention medications, and a substantial proportion (stroke 27.8%, CHD 25.8%) did not take any of these medications. In a fully adjusted analysis, increasing age, female gender, higher education, higher wealth in individual household, residence in a higher income country as well as being obese, hypertensive or diabetic were independent predictors of medication use.

Conclusion: The use of secondary prevention medication is low in ME and has not reached the modest recommended WHO target of 50% use of 3 or more medications. Independent factors of higher use were, better socioeconomic status (household wealth, country wealth and education) and better contact and accessibility to health care (increasing age, female gender, obesity, diabetes and hypertension).

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中东四国在社区环境中使用心血管疾病二级预防药物的情况。

背景：以证据为基础的国际临床实践指南普遍建议既往患有心血管疾病（CVD）的人服用二级预防药物。中东（ME）社区使用这些药物的数据有限：本研究评估了有心血管疾病（冠心病或中风）病史者使用循证二级预防药物的情况和预测因素：2005 年至 2015 年间，我们从四个中东部国家（阿拉伯联合酋长国（n = 1499）、沙特阿拉伯王国（n = 2046）、巴勒斯坦被占领土（n = 1668）和伊朗伊斯兰共和国（n = 6013））的 52 个城市社区和 35 个农村社区招募了 11228 名年龄在 35-70 岁之间的人。通过标准化问卷，我们报告了全国心血管疾病患者的用药情况，并通过多变量分析模型报告了用药情况的独立预测因素。研究结果在所有 ME 群体中，614 人（5.5%）患有心血管疾病，其中 115 人（1.0%）患有中风，523 人（4.7%）患有冠心病，24 人（0.2%）同时患有这两种疾病。心血管疾病患者的平均年龄为 56.6 ± 8.8 岁，269 人（43.8%）为女性。总体而言，仅有 23.5% 的心血管疾病患者报告使用了三种或三种以上经证实的二级预防药物，相当一部分患者（中风 27.8%，冠心病 25.8%）没有服用任何这些药物。在全面调整分析中，年龄增长、女性性别、受教育程度较高、家庭财富较多、居住在较高收入国家以及肥胖、高血压或糖尿病是预测药物使用的独立因素：结论：在 ME 中，二级预防药物的使用率较低，尚未达到世界卫生组织建议的 50%使用 3 种或 3 种以上药物的适度目标。使用率较高的独立因素包括：较好的社会经济地位（家庭财富、国家财富和教育程度）以及较好的医疗接触和可及性（年龄增长、女性性别、肥胖、糖尿病和高血压）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Global Heart Medicine-Cardiology and Cardiovascular Medicine

CiteScore

5.70

自引率

5.40%

发文量

审稿时长

5 weeks

期刊介绍： Global Heart offers a forum for dialogue and education on research, developments, trends, solutions and public health programs related to the prevention and control of cardiovascular diseases (CVDs) worldwide, with a special focus on low- and middle-income countries (LMICs). Manuscripts should address not only the extent or epidemiology of the problem, but also describe interventions to effectively control and prevent CVDs and the underlying factors. The emphasis should be on approaches applicable in settings with limited resources. Economic evaluations of successful interventions are particularly welcome. We will also consider negative findings if important. While reports of hospital or clinic-based treatments are not excluded, particularly if they have broad implications for cost-effective disease control or prevention, we give priority to papers addressing community-based activities. We encourage submissions on cardiovascular surveillance and health policies, professional education, ethical issues and technological innovations related to prevention. Global Heart is particularly interested in publishing data from updated national or regional demographic health surveys, World Health Organization or Global Burden of Disease data, large clinical disease databases or registries. Systematic reviews or meta-analyses on globally relevant topics are welcome. We will also consider clinical research that has special relevance to LMICs, e.g. using validated instruments to assess health-related quality-of-life in patients from LMICs, innovative diagnostic-therapeutic applications, real-world effectiveness clinical trials, research methods (innovative methodologic papers, with emphasis on low-cost research methods or novel application of methods in low resource settings), and papers pertaining to cardiovascular health promotion and policy (quantitative evaluation of health programs.