Use of statins for the prevention of cardiovascular disease in 41 low-income and middle-income countries: a cross-sectional study of nationally representative, individual-level data

Marcus, Maja-Emilia; Manne‐Goehler, Jennifer; Theilmann, Michaela; Farzadfar, Farshad; Moghaddam, Sahar Saeedi; Keykhaei, Mohammad; Hajebi, Amirali; Tschida, Scott; Lemp, Julia M.; Aryal, Krishna Kumar; Dunn, Matthew R.; Houéhanou, Corine; Bahendeka, Silver; Rohloff, Peter; Atun, Rifat; Bärnighausen, Till; Geldsetzer, Pascal; Ramírez‐Zea, Manuel; Chopra, Vineet; Heisler, Michele; Davies, Justine; Huffman, Mark D.; Vollmer, Sebastián; Flood, David

doi:10.1016/s2214-109x(21)00551-9

Cited by 48 publications

(45 citation statements)

References 30 publications

(54 reference statements)

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“…Furthermore, rates of tobacco smoking were substantial, and baseline statin use at STEMI presentation was low irrespective of glycemic status. These findings are aligned with a recent international cross-sectional analysis of LMICs that revealed fewer than one in every ten statin-eligible individuals to be using a statin for the primary prevention of cardiovascular disease [12]. As statin use for secondary prevention has been observed to be only modestly higher -approximately 20% of all eligible individuals -in LMICs [12], further investigation will be necessary to determine whether the high rate (99-100%) of statin utilization observed among NORIN STEMI participants at discharge persists long-term.…”

Section: Discussionsupporting

confidence: 80%

“…These findings are aligned with a recent international cross-sectional analysis of LMICs that revealed fewer than one in every ten statin-eligible individuals to be using a statin for the primary prevention of cardiovascular disease [12]. As statin use for secondary prevention has been observed to be only modestly higher -approximately 20% of all eligible individuals -in LMICs [12], further investigation will be necessary to determine whether the high rate (99-100%) of statin utilization observed among NORIN STEMI participants at discharge persists long-term. Given the increased disability-adjusted life years and lifetime medical costs associated with acute MI at a younger age, these data strongly stress the need for effective preventive strategies in LMICs.…”

Section: Discussionsupporting

confidence: 80%

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Missed Opportunities for Screening and Management of Dysglycemia among Patients Presenting with Acute Myocardial Infarction in North India: The Prospective NORIN STEMI Registry

Ostrominski

Vaduganathan

Mp³

et al. 2022

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Background: Dysglycemia is a major and increasingly prevalent cardiometabolic risk factor worldwide, but is often undiagnosed even in high-risk patients. We evaluated the impact of protocolized screening for dysglycemia on the prevalence of prediabetes and diabetes among patients presenting with ST-segment elevation myocardial infarction (STEMI) in North India. Methods:We conducted a prospective NORIN STEMI registry-based study of patients presenting with STEMI to two government-funded tertiary care medical centers in New Delhi, India, from January to November 2019. Hemoglobin A1c (HbA1c) was collected at presentation as part of the study protocol, irrespective of baseline glycemic status.Results: Among 3,523 participants (median age 55 years), 855 (24%) had known diabetes. In this group, baseline treatment with statins, sodium-glucose cotransporter 2 inhibitors, or glucagon-like peptide-1 receptor agonists was observed in 14%, <1%, and 1% of patients, respectively. For patients without known diabetes, protocolized inpatient screening identified 737 (28%) to have prediabetes (HbA1c 5.7-6.4%) and 339 (13%) to have newly detected diabetes (HbA1c ≥ 6.5%). Patients with prediabetes (49%), newly detected diabetes (53%), and established diabetes (48%) experienced higher rates of post-MI LV dysfunction as compared to euglycemic patients (42%). In-hospital mortality (5.6% for prediabetes, 5.1% for newly detected diabetes, 10.3% for established diabetes, 4.3% for euglycemia) and 30-day mortality (8.1%, 7.6%, 14.4%, 6.6%) were higher in patients with dysglycemia. Compared with euglycemia, prediabetes (adjusted odds ratio (aOR) 1.44 [1.12-1.85]), newly detected diabetes (aOR 1.57 [1.13-2.18]), and established diabetes (aOR 1.51 [1.19-1.94]) were independently associated with higher odds of composite 30-day all-cause mortality or readmission. 2 Ostrominski et al.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionsupporting

confidence: 80%

Missed Opportunities for Screening and Management of Dysglycemia among Patients Presenting with Acute Myocardial Infarction in North India: The Prospective NORIN STEMI Registry

Ostrominski

Vaduganathan

Mp³

et al. 2022

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“…WHO PEN recommends statins for the primary prevention of CVD for people with diabetes who are ≥40 years of age and for people without diabetes who have CVD risk >20% ( 7 ). Yet across low- and middle-income countries, including countries in the Region of the Americas, only 10% of people who are eligible for statin therapy for primary prevention receive treatment ( 6 , 23 ). Pragmatic strategies in the HEARTS framework to improve statin use among eligible people with hypertension and/or diabetes include simplified statin treatment protocols that may limit routine cholesterol measurements, use of ”polypills” containing both antihypertensive and statin agents, addition of other statins beyond simvastatin (e.g., atorvastatin) to national formularies via the PAHO Strategic Fund, and task sharing with non-physician health workers to routinely calculate CVD risk ( 24 ) (complementing the Team-Based Care module below).…”

Section: Integration Of Hypertension and Diabetes Care Within Heartsmentioning

confidence: 99%

Integrating hypertension and diabetes management in primary health care settings: HEARTS as a tool

Flood

Edwards

Giovannini

et al. 2022

Revista Panamericana De Salud Pública

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Hypertension and diabetes are modifiable cardiovascular disease (CVD) risk factors that contribute to nearly one-third of all deaths in the Americas Region each year (2.3 million deaths). Despite advances in the detection and clinical management of hypertension and diabetes, there are substantial gaps in their implementation globally and in the Region. The considerable overlap in risk factors, prognosis, and treatment of hypertension and diabetes creates a unique opportunity for a unified implementation model for management at the population level. This report highlights one such high-profile effort, the Pan American Health Organization’s “HEARTS in the Americas” program, based on the World Health Organization’s HEARTS Technical Package for Cardiovascular Disease Management in Primary Health Care. The HEARTS program aims to improve the implementation of preventive CVD care in primary health systems using six evidence-based, pragmatic components: Healthy-lifestyle counseling, Evidence-based protocols, Access to essential medicines and technology, Risk-based CVD management, Team-based care, and Systems for monitoring. To date, HEARTS implementation projects have focused primarily on hypertension given that it is the leading modifiable CVD risk factor and can be treated cost-effectively. The objective of this report is to describe opportunities for integration of diabetes clinical care and policy within the HEARTS hypertension framework. A substantial global burden of disease could be averted with integrated primary care management of these conditions. Thus, there is an urgency in applying lessons from HEARTS to close these implementation gaps and improve the integrated detection, treatment, and control of diabetes and hypertension.

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“…Although diet, lifestyle, and other atherosclerotic cardiovascular disease risk factors such as cigarette smoking and hypertension must be addressed, lipid-lowering therapy with statins, which are now inexpensive and universally available, is underutilised. In The Lancet Global Health, Maja Marcus and colleagues 9 report that this is particularly the case in 41 geographically and economically diverse low-income and middle-income countries, where 1 in 10 people who were eligible for primary prevention (8·0%, 95% CI 6·9–9·3) and 1 in 5 people with established atherosclerotic cardiovascular disease were prescribed statins. 9 …”

mentioning

confidence: 99%

“…In The Lancet Global Health, Maja Marcus and colleagues 9 report that this is particularly the case in 41 geographically and economically diverse low-income and middle-income countries, where 1 in 10 people who were eligible for primary prevention (8·0%, 95% CI 6·9–9·3) and 1 in 5 people with established atherosclerotic cardiovascular disease were prescribed statins. 9 …”

mentioning

confidence: 99%

Statins: are they appropriate for all patients?

Raal

Mohamed

2022

The Lancet Global Health

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Use of statins for the prevention of cardiovascular disease in 41 low-income and middle-income countries: a cross-sectional study of nationally representative, individual-level data

Cited by 48 publications

References 30 publications

Missed Opportunities for Screening and Management of Dysglycemia among Patients Presenting with Acute Myocardial Infarction in North India: The Prospective NORIN STEMI Registry

Missed Opportunities for Screening and Management of Dysglycemia among Patients Presenting with Acute Myocardial Infarction in North India: The Prospective NORIN STEMI Registry

Integrating hypertension and diabetes management in primary health care settings: HEARTS as a tool

Statins: are they appropriate for all patients?

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