EURO PEAN SOCI ETY OF CARDIOLOGY ® Original scientific paper Socioeconomic factors and use of secondary preventive therapies for cardiovascular diseases in South Asia: The PURE study Rajeev Gupta 1 , Shofiqul Islam 2 , Prem Mony 3 , V Raman Kutty 4 , Viswanathan Mohan 5 , Rajesh Kumar 6 , JS Thakur 6 , V Kiruba Shankar 3 , Deepa Mohan 5 , K Vijayakumar 4 , Omar Rahman 7 , Rita Yusuf 7 , Romaina Iqbal 8 , Mohammed Shahid 9 , Indu Mohan 1 , Sumathy Rangarajan 2 , Koon K Teo 2 and Salim Yusuf 2 Abstract Objective: The purpose of this study was to determine the association of socioeconomic factors on use of cardio- protective medicines in known coronary heart disease (CHD) or stroke in South Asia. Methods: We enrolled 33,423 subjects aged 35–70 years (women 56%, rural 53%, low education 51%, low household wealth 25%) in 150 communities in India, Pakistan and Bangladesh during 2003–2009. Information regarding socio- economic status, disease conditions and treatments was recorded. We studied influence of rural location, educational status and household wealth on use of drug therapies. Odds ratios (ORs) and 95% confidence intervals were calculated. Results: CHD was reported in 683 (2.0%), stroke 316 (0.9%), and CHD/stroke in 970 (2.9%). Median duration since diagnosis was four years. Participants with CHD/stroke were older with greater prevalence of smoking, overweight, hypertension and diabetes (p < 0.01). In patients with CHD, stroke and CHD/stroke, respectively, use (%) of antiplatelets was 11.6, 3.8 and 9.3, beta-blockers 11.9, 7.0 and 10.4, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers 6.4, 1.9 and 5.3 and statins 4.8, 0.6 and 3.5. In CHD/stroke patients any one of these drugs was used in 18.1%, any two in 7.2%, any three in 2.8% and none in 81.5%. Details of drug dose were not available. Use of drugs was significantly lower in rural low education and low wealth index participants (all p < 0.01). Low wealth index participants had the lowest use of these therapies with no attenuation after multiple adjustments. Conclusion: The use of secondary preventive drug therapies in patients with known CHD or stroke in South Asia is low with over 80% receiving none of the effective drug treatments. Low household wealth is the most important determinant. Keywords Cardiovascular disease, coronary heart disease, epidemiology, low income countries, secondary prevention Received 2 February 2014; accepted 30 May 2014 1 Department of Medicine, Fortis Escorts Hospital, India 2 Population Health Research Institute and Hamilton Health Sciences, McMaster University, Canada 3 St John’s Research Institute, St John’s Medical College, India 4 Health Action by People, India 5 Madras Diabetes Research Foundation, India 6 School of Public Health, Postgraduate Institute of Medical Education and Research, India 7 Department of Public Health, Independent University, Bangladesh 8 Department of Community Health Sciences, Aga Khan University, Pakistan 9 Department of Emergency Medicine, Indus Hospital, Pakistan Corresponding author: Rajeev Gupta, Department of Medicine, Fortis Escorts Hospital, Malviya Nagar, JLN Marg, Jaipur 302017 India. Email: rajeevgg@gmail.com European Journal of Preventive Cardiology 2015, Vol. 22(10) 1261–1271 ! The European Society of Cardiology 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/2047487314540386 ejpc.sagepub.com Downloaded from https://academic.oup.com/eurjpc/article/22/10/1261/5927029 by guest on 03 April 2023