Shehab Uddin Al Abid, Md Mostafa Monower, Ahmad K Abrar, Jannat A Riva, Mahfuzur Rahman Bhuiyan, Mohammad Abdullah Al-Mamun, Sohel Reza Choudhury
{"title":"他汀类药物用于孟加拉国心血管疾病一级和二级预防的负担和预测因素：来自全国代表性调查的证据","authors":"Shehab Uddin Al Abid, Md Mostafa Monower, Ahmad K Abrar, Jannat A Riva, Mahfuzur Rahman Bhuiyan, Mohammad Abdullah Al-Mamun, Sohel Reza Choudhury","doi":"10.5334/gh.1412","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Large-scale randomized trials have established the efficacy and safety of statin therapy in preventing cardiovascular diseases (CVDs) among individuals at increased risk (i.e., primary prevention) or those with pre-existing cardiovascular disease (i.e., secondary prevention). Consequently, recent international guidelines, including those from the WHO and ACC/AHA, have expanded the eligibility criteria for statin therapy.</p><p><strong>Objective: </strong>To assess the current burden of statin-eligible populations in Bangladesh, evaluate the current state of statin use, and identify factors associated with non-use of statins.</p><p><strong>Methods: </strong>We analysed data from 3,140 adults aged 40 to 69 years from the nationally representative WHO-STEPS Bangladesh 2018 survey. Statin therapy eligibility for primary prevention was assessed using the WHO-2019 and the ACC/AHA-2018 guidelines separately. Individuals with a previous history of CVD were eligible for secondary prevention under both guidelines. Modified Poisson regression models identified factors associated with statin use. All analyses were conducted using appropriate survey weights.</p><p><strong>Findings: </strong>Among the participants, 443 (14.1%) reported a previous history of CVD. Of those without CVD, 11.2% (95% CI: 9.7-12.9) and 32.3% (95% CI: 30.0-34.6) were eligible for statin use for primary prevention according to the WHO-2019 and the ACC/AHA-2018 guidelines, respectively. Among adults eligible according to WHO-2019 guideline, 6.9% (95% CI: 4.1-11.5) were using statins, while among those eligible according to ACC/AHA-2018 guideline, 3.3% (95% CI: 2.1-5.1) were using statins. For secondary prevention, 23.5% (95% CI: 16.9-31.6) of adults with prior CVD were using statins. Non-use was higher among younger adults, those without regular health visits or cholesterol measurements, and those from the Mymensingh or Rajshahi divisions.</p><p><strong>Interpretation: </strong>In Bangladesh, approximately one in twenty eligible individuals uses statins for primary prevention of CVD, and one in five individuals for secondary prevention. Appropriate population health interventions are needed to scale up statin use to mitigate the burden of CVD.</p>","PeriodicalId":56018,"journal":{"name":"Global Heart","volume":"20 1","pages":"28"},"PeriodicalIF":3.0000,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11908426/pdf/","citationCount":"0","resultStr":"{\"title\":\"Burden and Predictors of Statin Use for Primary and Secondary Prevention of Cardiovascular Disease in Bangladesh: Evidence from a Nationally Representative Survey.\",\"authors\":\"Shehab Uddin Al Abid, Md Mostafa Monower, Ahmad K Abrar, Jannat A Riva, Mahfuzur Rahman Bhuiyan, Mohammad Abdullah Al-Mamun, Sohel Reza Choudhury\",\"doi\":\"10.5334/gh.1412\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Large-scale randomized trials have established the efficacy and safety of statin therapy in preventing cardiovascular diseases (CVDs) among individuals at increased risk (i.e., primary prevention) or those with pre-existing cardiovascular disease (i.e., secondary prevention). Consequently, recent international guidelines, including those from the WHO and ACC/AHA, have expanded the eligibility criteria for statin therapy.</p><p><strong>Objective: </strong>To assess the current burden of statin-eligible populations in Bangladesh, evaluate the current state of statin use, and identify factors associated with non-use of statins.</p><p><strong>Methods: </strong>We analysed data from 3,140 adults aged 40 to 69 years from the nationally representative WHO-STEPS Bangladesh 2018 survey. Statin therapy eligibility for primary prevention was assessed using the WHO-2019 and the ACC/AHA-2018 guidelines separately. Individuals with a previous history of CVD were eligible for secondary prevention under both guidelines. Modified Poisson regression models identified factors associated with statin use. All analyses were conducted using appropriate survey weights.</p><p><strong>Findings: </strong>Among the participants, 443 (14.1%) reported a previous history of CVD. Of those without CVD, 11.2% (95% CI: 9.7-12.9) and 32.3% (95% CI: 30.0-34.6) were eligible for statin use for primary prevention according to the WHO-2019 and the ACC/AHA-2018 guidelines, respectively. Among adults eligible according to WHO-2019 guideline, 6.9% (95% CI: 4.1-11.5) were using statins, while among those eligible according to ACC/AHA-2018 guideline, 3.3% (95% CI: 2.1-5.1) were using statins. For secondary prevention, 23.5% (95% CI: 16.9-31.6) of adults with prior CVD were using statins. Non-use was higher among younger adults, those without regular health visits or cholesterol measurements, and those from the Mymensingh or Rajshahi divisions.</p><p><strong>Interpretation: </strong>In Bangladesh, approximately one in twenty eligible individuals uses statins for primary prevention of CVD, and one in five individuals for secondary prevention. Appropriate population health interventions are needed to scale up statin use to mitigate the burden of CVD.</p>\",\"PeriodicalId\":56018,\"journal\":{\"name\":\"Global Heart\",\"volume\":\"20 1\",\"pages\":\"28\"},\"PeriodicalIF\":3.0000,\"publicationDate\":\"2025-03-12\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11908426/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Global Heart\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.5334/gh.1412\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q2\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Global Heart","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.5334/gh.1412","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Burden and Predictors of Statin Use for Primary and Secondary Prevention of Cardiovascular Disease in Bangladesh: Evidence from a Nationally Representative Survey.
Background: Large-scale randomized trials have established the efficacy and safety of statin therapy in preventing cardiovascular diseases (CVDs) among individuals at increased risk (i.e., primary prevention) or those with pre-existing cardiovascular disease (i.e., secondary prevention). Consequently, recent international guidelines, including those from the WHO and ACC/AHA, have expanded the eligibility criteria for statin therapy.
Objective: To assess the current burden of statin-eligible populations in Bangladesh, evaluate the current state of statin use, and identify factors associated with non-use of statins.
Methods: We analysed data from 3,140 adults aged 40 to 69 years from the nationally representative WHO-STEPS Bangladesh 2018 survey. Statin therapy eligibility for primary prevention was assessed using the WHO-2019 and the ACC/AHA-2018 guidelines separately. Individuals with a previous history of CVD were eligible for secondary prevention under both guidelines. Modified Poisson regression models identified factors associated with statin use. All analyses were conducted using appropriate survey weights.
Findings: Among the participants, 443 (14.1%) reported a previous history of CVD. Of those without CVD, 11.2% (95% CI: 9.7-12.9) and 32.3% (95% CI: 30.0-34.6) were eligible for statin use for primary prevention according to the WHO-2019 and the ACC/AHA-2018 guidelines, respectively. Among adults eligible according to WHO-2019 guideline, 6.9% (95% CI: 4.1-11.5) were using statins, while among those eligible according to ACC/AHA-2018 guideline, 3.3% (95% CI: 2.1-5.1) were using statins. For secondary prevention, 23.5% (95% CI: 16.9-31.6) of adults with prior CVD were using statins. Non-use was higher among younger adults, those without regular health visits or cholesterol measurements, and those from the Mymensingh or Rajshahi divisions.
Interpretation: In Bangladesh, approximately one in twenty eligible individuals uses statins for primary prevention of CVD, and one in five individuals for secondary prevention. Appropriate population health interventions are needed to scale up statin use to mitigate the burden of CVD.
Global HeartMedicine-Cardiology and Cardiovascular Medicine
CiteScore
5.70
自引率
5.40%
发文量
77
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.
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