New Research Exposes a Shocking Global Failure in Heart Disease Treatment

A major international study reveals that most people with cardiovascular disease are not receiving essential medications to prevent further heart issues.

Over 12 years, researchers found shockingly low usage rates, with declines in many regions, particularly in low-income countries. Experts stress that these life-saving drugs are inexpensive and widely available, making their underuse a preventable crisis. Urgent action is needed to close the treatment gap and save lives.

Cardiovascular Medications Are Underused Worldwide

A new study published today (February 3) in JACC, the flagship journal of the American College of Cardiology, reveals that life-saving medications for preventing further heart issues in people with cardiovascular disease (CVD) are widely underused worldwide. Despite global efforts, the study, which tracked participants from 17 countries over 12 years, found little improvement in medication use.

Secondary prevention of CVD aims to reduce the risk of future heart attacks, strokes, heart failure, and premature death in individuals already diagnosed with the disease. This is achieved through lifestyle changes, medications, and medical treatments. Without proper intervention, these patients face significantly higher health risks. Over the past decade, major health organizations like the World Health Organization (WHO) and the United Nations (UN) have set goals to lower CVD-related deaths by increasing access to proven treatments, yet progress remains slow.

Persistent Gaps in Medication Usage

“After examining the progress of medication use for secondary cardiovascular (CVD) prevention, our research indicates that there continues to be substantial under-utilization of these medications with little improvement over time, and that global targets are unlikely to be reached,” said Dr. Philip Joseph, lead author of the study and scientist at the Population Health Research Institute (PHRI) – a joint institute of McMaster University and Hamilton Health Sciences, Canada.

The PHRI Prospective Urban Rural Epidemiology (PURE) study, a multi-national, community-based, prospective cohort study, analyzed over 11,000 participants with diagnosed CVD between 30-70 years of age over 12 years. Participants were from communities in countries at different income levels and were selected based on criteria representing urban and rural areas.

How Medication Use Varies by Country Income Levels

Participating countries include: (income level based on their World Bank classification at the time of starting the study)

• High-income: Canada, Sweden, United Arab Emirates
• Upper-middle-income: Argentina, Brazil, Chile, Malaysia, Poland, South Africa, Türkiye
• Lower-middle-income: China, Colombia, Iran
• Low-income: Bangladesh, India, Pakistan, Zimbabwe

Troubling Declines in Medication Use Over Time

Research results showed that medication use for secondary CVD prevention varied by country income level and was lower at the last study visit compared to the first visit in every income level except for upper-middle-income countries.

Overall, the use of at least one medication for secondary prevention started at 41.3% at the baseline study visit, peaked at 43.1%, and dropped to 31.3% at the last study visit. In high-income countries, use declined from 88.8% to 77.3%. In upper-middle-income countries, it rose from 55% to 61.1%. In lower-middle-income countries, it began at 29.5%, peaked at 31.7%, and fell to 13.4%. In low-income countries, it increased from 20.8% to a peak of 47.3%, then declined to 27.5%. Use of three or more proven medication classes for secondary prevention was substantially lower in all country income levels.

A Widespread Failure in CVD Treatment Strategies

“Our findings suggest that current secondary prevention strategies continue to leave the majority of people with CVD either untreated or undertreated and highlight the general lack of progress being made to increase the use of secondary CVD prevention medications in most parts of the world,” Joseph said.

“This landmark study underscores an immense opportunity to improve global cardiovascular health,” said Harlan M. Krumholz, MD, SM, Harold H. Hines Jr. Professor at Yale School of Medicine and Editor-in-Chief of JACC. “It is unacceptable that so many individuals worldwide who have already experienced heart disease are not receiving readily available and inexpensive treatments that could save lives and prevent further events. We have the tools to bridge this gap in care now—and we must act urgently.”

Study Limitations and Future Considerations

Limitations of the study include the analysis of only seventeen countries, although they were from a broad range of geographical areas as well as levels of economic development. The potential for participants to have underestimated their medication use may have caused limitations, including the unknown extent to which changes in cohort demographics, CVD duration or severity impacted variations in medication use over time. Lastly, the COVID-19 pandemic restricted the ability to conduct research in some countries during part of the last follow-up visit cycle.

Reference: “Secondary Prevention Medications in 17 Countries Grouped by Income Level (PURE)” by Philip Joseph, Álvaro Avezum, Chinthanie Ramasundarahettige, Prem K. Mony, Rita Yusuf, Khawar Kazmi, Andrzej Szuba, Patricio Lopez-Jaramillo, Maria Luz Diaz, Afzal Hussein Yusufali, Sadi Gulec, Roya Kelishadi, Li Wei, Jephat Chifamba, Fernando Lanas, Thandi Puoane, Ambigga Krishnapillai, Sumathy Rangarajan, Salim Yusuf and Lennon Gwaunza, 3 February 2025, Journal of the American College of Cardiology.
DOI: 10.1016/j.jacc.2024.10.121

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