PURE trial - Summary & Results
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The PURE study surveyed 153,996 adults from various economic backgrounds to assess the impact of societal influences on lifestyle behaviors and cardiovascular disease (CVD) drug utilization from 2003 to 2009. Findings revealed significant disparities in cardiovascular drug use for secondary prevention among patients with coronary heart disease or stroke, showing higher usage in high-income countries versus lower-income areas. The study underscores a global inadequacy in CVD drug access, particularly in rural and lower-income populations, emphasizing the need for targeted preventive strategies.
PURE trial - Summary & Results
- 1. PURE (Prospective Urban Rural Epidemiology)
- 2. PURE (Prospective Urban Rural Epidemiology) S Yusuf (McMaster University, Hamilton, ON) European Society of Cardiology 2011 Congress • A survey of 153 996 adults to examine the relationship of societal influences on human lifestyle behaviors, CV risk factors, and incidence of chronic noncommunicable diseases • Time period: 2003–2009 • Population categories: Urban and rural communities in countries categorized as high-income (Canada, Sweden, and United Arab Emirates), upper-middle-income (Argentina, Brazil, Chile, Malaysia, Poland, South Africa, and Turkey), lower- middle-income (China, Colombia, and Iran), and low-income (Bangladesh, India, Pakistan, and Zimbabwe) • Analyzed the use of antiplatelets, beta blockers, ACE inhibitors or ARBs, statins, and other agents among persons with CHD or stroke ACE=angiotensin-converting enzyme; ARB=angiotensin receptor blocker; CHD=coronary heart disease
- 3. PURE: Results (by economic status) CV drug use for secondary prevention among patients with CHD or stroke, by nation economic status CV drug category High-income (%) Upper-middle Lower-middle Low-income Overall income (%) income (%) (%) Antiplatelets 62.0 24.6 21.9 8.8 25.3 Beta blockers 40.0 25.4 10.2 9.7 17.4 ACE inhibitors or ARBs 49.8 30.0 11.1 5.2 19.5 BP-lowering agents 73.8 48.4 37.4 19.2 41.8 Statins 66.5 17.6 4.3 3.3 14.6 All decreasing trends from higher- to lower-income, p<0.0001
- 4. PURE: Results (urban vs rural) CV drug use for secondary prevention among patients with CHD or stroke, urban vs rural populations across all surveyed countries CV drug category Urban (%) Rural (%) Antiplatelets 27.7 21.5 Beta blockers 20.3 13.1 ACE inhibitors or ARBs 22.3 15.4 BP-lowering agents 47.1 33.7 Statins 17.2 10.6 All differences urban vs rural, p<0.001
- 5. PURE: Commentary* "These are the cheapest, the safest, and the most effective drugs. And yet we have a collective global failure." - Dr Salim Yusuf "A real improvement in global cardiovascular health could likely be obtained through preventive strategies focused on the well-known risk factors, including lifestyle changes." - Dr Aldo Pietro Maggioni *All comments from PURE: CV drugs underused in poor nations, rural populations (http://www.theheart.org/article/1268617.do)
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