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

Journal article

S.G.K. Yoo, G.S. Chung, S.K. Bahendeka, A.M. Sibai, A. Damasceno, F. Farzadfar, P. Rohloff, C. Houehanou, B. Norov, K.B. Karki, M. Azangou-Khyavy, M.E. Marcus, K.K. Aryal, L.C.C. Brant, M. Theilmann, R. C{\'i}fkov{\'a}, N. Lunet, M.S. Gurung, J.K. Mwangi, J. Martins, R. Haghshenas, L. Sturua, S. Vollmer, T. B{\"a}rnighausen, R. Atun, J.B. Sussman, K. Singh, S. Saeedi Moghaddam, D. Guwatudde, P. Geldsetzer, J. Manne-Goehler, M.D. Huffman, J.I. Davies, D. Flood
JAMA, vol. 330(8), 2023, pp. 715-724

DOI: 10.1001/jama.2023.12905

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APA Click to copy
Yoo, S. G. K., Chung, G. S., Bahendeka, S. K., Sibai, A. M., Damasceno, A., Farzadfar, F., … Flood, D. (2023). Aspirin for Secondary Prevention of Cardiovascular Disease in 51 Low-, Middle-, and High-Income Countries. JAMA, 330(8), 715–724. https://doi.org/10.1001/jama.2023.12905

Chicago/Turabian Click to copy
Yoo, S.G.K., G.S. Chung, S.K. Bahendeka, A.M. Sibai, A. Damasceno, F. Farzadfar, P. Rohloff, et al. “Aspirin for Secondary Prevention of Cardiovascular Disease in 51 Low-, Middle-, and High-Income Countries.” JAMA 330, no. 8 (2023): 715–724.

MLA Click to copy
Yoo, S. G. K., et al. “Aspirin for Secondary Prevention of Cardiovascular Disease in 51 Low-, Middle-, and High-Income Countries.” JAMA, vol. 330, no. 8, 2023, pp. 715–24, doi:10.1001/jama.2023.12905.

BibTeX Click to copy

@article{yoo2023a,
  title = {Aspirin for Secondary Prevention of Cardiovascular Disease in 51 Low-, Middle-, and High-Income Countries},
  year = {2023},
  issue = {8},
  journal = {JAMA},
  pages = {715-724},
  volume = {330},
  doi = {10.1001/jama.2023.12905},
  author = {Yoo, S.G.K. and Chung, G.S. and Bahendeka, S.K. and Sibai, A.M. and Damasceno, A. and Farzadfar, F. and Rohloff, P. and Houehanou, C. and Norov, B. and Karki, K.B. and Azangou-Khyavy, M. and Marcus, M.E. and Aryal, K.K. and Brant, L.C.C. and Theilmann, M. and C{\'i}fkov{\'a}, R. and Lunet, N. and Gurung, M.S. and Mwangi, J.K. and Martins, J. and Haghshenas, R. and Sturua, L. and Vollmer, S. and B{\"a}rnighausen, T. and Atun, R. and Sussman, J.B. and Singh, K. and Saeedi Moghaddam, S. and Guwatudde, D. and Geldsetzer, P. and Manne-Goehler, J. and Huffman, M.D. and Davies, J.I. and Flood, D.}
}

Abstract

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.