Journal Article

Aspirin for Secondary Prevention of Cardiovascular Disease in 51 Low-, Middle-, and High-Income Countries

Authors

  • Yoo
  • S. G. K.; Chung
  • G. S.; Bahendeka
  • S. K.; Sibai
  • A. M.; Damasceno
  • A.; Farzadfar
  • F.; Rohloff
  • P.; Houehanou
  • C.; Norov
  • B.; Karki
  • K. B.; Azangou-Khyavy
  • M.; Marcus
  • M. E.; Aryal
  • K. K.; Brant
  • L. CC.; Theilmann
  • M.; Cífková
  • R.; Lunet
  • N.; Gurung
  • M. S.; Kibachio Mwangi
  • J.; Martins
  • J.; Haghshenas
  • R.; Sturua
  • L.; Vollmer
  • S.; Bärnighausen
  • T.; Atun
  • R.; Sussman
  • J. B.; Singh
  • K.; Saeedi Moghaddam
  • S.; Guwatudde
  • D.; Geldsetzer
  • P.; Manne-Goehler
  • J.; Huffman
  • M. D.; Davies
  • J. I.; Flood
  • D.
Publication Date

Importance Aspirin is an effective and low-cost option for reducing atherosclerotic cardiovascular disease (CVD) events and improving mortality rates among individuals with established CVD. To guide efforts to mitigate the global CVD burden, there is a need to understand current levels of aspirin use for secondary prevention of CVD.

 

Objective To report and evaluate aspirin use for secondary prevention of CVD across low-, middle-, and high-income countries.

 

Design, Setting, and Participants Cross-sectional analysis using pooled, individual participant data from nationally representative health surveys conducted between 2013 and 2020 in 51 low-, middle-, and high-income countries. Included surveys contained data on self-reported history of CVD and aspirin use. The sample of participants included nonpregnant adults aged 40 to 69 years.

 

Exposures Countries’ per capita income levels and world region; individuals’ socioeconomic demographics.

 

Main Outcomes and Measures Self-reported use of aspirin for secondary prevention of CVD.

 

Results The overall pooled sample included 124 505 individuals. The median age was 52 (IQR, 45-59) years, and 50.5% (95% CI, 49.9%-51.1%) were women. A total of 10 589 individuals had a self-reported history of CVD (8.2% [95% CI, 7.7%-8.6%]). Among individuals with a history of CVD, aspirin use for secondary prevention in the overall pooled sample was 40.3% (95% CI, 37.6%-43.0%). By income group, estimates were 16.6% (95% CI, 12.4%-21.9%) in low-income countries, 24.5% (95% CI, 20.8%-28.6%) in lower-middle-income countries, 51.1% (95% CI, 48.2%-54.0%) in upper-middle-income countries, and 65.0% (95% CI, 59.1%-70.4%) in high-income countries.

 

Conclusion and Relevance Worldwide, aspirin is underused in secondary prevention, particularly in low-income countries. National health policies and health systems must develop, implement, and evaluate strategies to promote aspirin therapy.

Kiel Institute Expert

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