Secondary prevention of coronary heart disease: a cross-sectional analysis on the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Abstract

BACKGROUND: Coronary heart disease (CHD) remains a major cause of mortality worldwide and in Brazil. Use of standard medications after CHD has been proven to avoid new events and reduce early mortality. OBJECTIVES: This study aimed to analyze secondary prevention of CHD and its association with the baseline characteristics of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). DESIGN AND SETTING: Cross-sectional analysis on ELSA-Brasil data. METHODS: Secondary prevention of CHD recommended in standard guidelines (antiplatelet plus beta-blocker plus lipid-lowering drug, with or without angiotensin-converting enzyme inhibitors, ACEI, or angiotensin receptor blockers, ARB) was evaluated in relation to sociodemographic data and the time since the coronary event. The chi-square test, one-way analysis of variance (ANOVA) and Mann-Whitney test were performed, as necessary. RESULTS: Among 15,094 participants, 2.7% reported a previous diagnosis of CHD. Use of recommended drugs for secondary prevention was reported by almost 35% of the participants. Medication use for secondary prevention was generally more frequent among high-income participants than among low-income participants. Use of ARB and ACEI was different between participants who had private health insurance and those who only used the public healthcare system. Men were more likely to use medication than women. The frequency with which participants used the recommended drugs was similar in all time periods after CHD, but use of only one drug increased progressively across time periods. CONCLUSION: The use of medication for secondary prevention of CHD was lower than what is recommended in standardized guidelines, especially among women and lower-income participants.

Secondary prevention of cardiovascular disease in Brazil: lessons from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

“…9 ELSA-Brasil also presented important data correlating the use of medication for secondary prevention with socioeconomic status. In both studies, 6,7 the use of secondary prevention was higher among participants with high socioeconomic status than among participants with low socioeconomic status. One crucial point needs to be noted here: the sample for ELSA-Brasil comprised civil servants with high educational attainment and monthly family income, compared with the general population in Brazil.…”

“…5 Recent data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) have presented similar results. 6,7 ELSA-Brasil is a prospective cohort study of 15,105 civil servants in six cities in Brazil (Belo Horizonte, Porto Alegre, Rio de Janeiro, Salvador, São Paulo and Vitória).…”

“…Moreover, both studies highlighted a critical point: secondary prevention was less used among women than among men. 6,7 This lack of secondary cardiovascular prevention is not a scientific secret, and also it is not an exclusively Brazilian problem. Some other studies have shown lower frequency of use of medication for secondary prevention of cardiovascular disease among women than among men.…”

Prevalence of pharmacological adherence in patients with coronary artery disease and associated factors

“…The sample size was calculated ( 13 ) using the R 3.4.1 software, based on data from a previous study, which identified adequate pharmacological adherence in 56.5% ( 7 ) of the patients with CAD. Considering an 80% power and a 10% accuracy, a minimum sample size of 198 patients was obtained.…”

“…Therefore, during the delivery of nursing care for inpatients or outpatients, nurses must assess the factors associated with pharmacological non-adherence, so that nursing interventions can be established individually and focused on these variables. To the best of the authors’ knowledge, only three Brazilian studies that evaluated the factors associated with pharmacological non-adherence in patients with CAD were identified ( 7 , 9 , 12 ) . Thus, new studies are needed, with population samples from different locations and addressing other possible non-adherence factors.…”