Background Although most
cardiovascular disease occurs in low-
income and middle-
income countries, little is known about the use of effective
secondary prevention medications in these
communities . We aimed to assess use of proven effective
secondary preventive
drugs (
antiplatelet drugs , â blockers,
angiotensin -converting-
enzyme [ACE] inhibitors or
angiotensin -receptor blockers [ARBs], and
statins ) in individuals with a
history of
coronary heart disease or
stroke .MethodsIn the Prospective Urban Rural Epidemiological (PURE) study, we recruited individuals
aged 3570 years from rural and urban
communities in countries at various stages of
economic development . We assessed rates of previous
cardiovascular disease (
coronary heart disease or
stroke ) and use of proven effective
secondary preventive
drugs and
blood -
pressure -lowering
drugs with standardised
questionnaires , which were completed by
telephone interviews ,
household visits, or on
patient 's presentation to clinics. We
report estimates of
drug use at national,
community , and individual levels.FindingsWe enrolled 153 996
adults from 628 urban and
rural communities in countries with
incomes classified as high (three countries), upper-middle (seven), lower-middle (three), or low (four) between January, 2003, and December, 2009. 5650 participants had a
self -reported
coronary heart disease event (median 5·0 years previously [IQR 2·010·0]) and 2292 had
stroke (4·0 years previously [2·08·0]). Overall, few individuals with
cardiovascular disease took
antiplatelet drugs (25·3%), â blockers (17·4%),
ACE inhibitors or ARBs (19·5%), or
statins (14·6%). Use was highest in high-
income countries (
antiplatelet drugs 62·0%, â blockers 40·0%,
ACE inhibitors or ARBs 49·8%, and
statins 66·5%), lowest in low-
income countries (8·8%, 9·7%, 5·2%, and 3·3%, respectively), and decreased in line with reduction of country
economic status (ptrend<0·0001 for every
drug type)...