title: Secondary CV Prevention in South America in a Community Setting: The PURE Study.
abstract: Despite the availability of evidence-based therapies, there is no information on the use of medications for the secondary prevention of cardiovascular disease in urban and rural community settings in South America.
  
  
  
  This study sought to assess the use, and its predictors, of effective secondary prevention therapies in individuals with a history of coronary heart disease (CHD) or stroke.
  
  
  
  In the PURE (Prospective Urban Rural Epidemiological) study, we enrolled 24,713 individuals from South America ages 35 to 70 years from 97 rural and urban communities in Argentina, Brazil, Chile, and Colombia. We assessed the use of proven therapies with standardized questionnaires. We report estimates of drug use at national, community, and individual levels and the independent predictors of their utilization through a multivariable analysis model.
  
  
  
  Of 24,713 individuals, 910 had a self-reported CHD event (at a median of 5 years earlier) and 407 had stroke (6 years earlier). The proportions of individuals with CHD who received antiplatelet medications (30.1%), beta-blockers (34.2%), angiotensin-converting enzyme inhibitors, or angiotensin-receptor blockers (36.0%), or statins (18.0%) were low; with even lower proportions among stroke patients (antiplatelets 24.3%, angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers 37.6%, statins 9.8%). A substantial proportion of patients did not receive any proven therapy (CHD 31%, stroke 54%). A minority of patients received either all 4 (4.1%) or 3 proven therapies (3.3%). Male sex, age >60 years, better education, more wealth, urban location, diabetes, and obesity were associated with higher rates of medication use. In a multivariable model, markers of wealth had the largest impact in secondary prevention.
  
  
  
  There are large gaps in the use of proven medications for secondary prevention of cardiovascular disease in South America. Strategies to improve the sustained use of these medications will likely reduce cardiovascular disease burden substantially.
authors: Dante Pazzanese Institute of Cardiology, São Paulo, Brazil. Electronic address: avezumjr@uol.com.br.
authors: Alvaro
authors: A
authors: Avezum
authors: Dante Pazzanese Institute of Cardiology, São Paulo, Brazil.
authors: Gustavo B F
authors: GBF
authors: Oliveira
authors: Universidad de la Frontera, Temuco, Chile.
authors: Fernando
authors: F
authors: Lanas
authors: Fundacion Oftalmologica de Santander (FOSCAL), Medical School, Universidad de Santander, Bucaramanga, Colombia.
authors: Patricio
authors: P
authors: Lopez-Jaramillo
authors: Estudios Clínicos Latinoamérica, Rosario, Argentina.
authors: Rafael
authors: R
authors: Diaz
authors: Universidad Peruana Cayetano Heredia, Lima, Peru.
authors: J Jaime
authors: JJ
authors: Miranda
authors: Universidad de la Frontera, Temuco, Chile.
authors: Pamela
authors: P
authors: Seron
authors: Fundacion Oftalmologica de Santander (FOSCAL), Medical School, Universidad de Santander, Bucaramanga, Colombia.
authors: Paul A
authors: PA
authors: Camacho-Lopez
authors: Estudios Clínicos Latinoamérica, Rosario, Argentina.
authors: Andres
authors: A
authors: Orlandini
authors: Universidad Peruana Cayetano Heredia, Lima, Peru.
authors: Antonio
authors: A
authors: Bernabe-Ortiz
authors: Dante Pazzanese Institute of Cardiology, São Paulo, Brazil.
authors: Antônio
authors: A
authors: Cordeiro Mattos
authors: Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
authors: Shofiqul
authors: S
authors: Islam
authors: Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
authors: Sumathy
authors: S
authors: Rangarajan
authors: Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
authors: Koon
authors: K
authors: Teo
authors: Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
authors: Salim
authors: S
authors: Yusuf
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control*; D003906:Developing Countries; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D011446:Prospective Studies; D012424:Rural Population; D055502:Secondary Prevention / Q000379:methods*; D017678:Sex Distribution; D013020:South America / Q000453:epidemiology; D014505:Urban Population
chemical_list: D002317:Cardiovascular Agents