Cardiovascular Medication Use Varies By Country in Terms of Affordability, Availability

aspirin prevention cardiovascular disease
aspirin prevention cardiovascular disease
An analysis of PURE study data shows affordability and availability of CVD medication varies by country and patient income level.

The availability and affordability of 4 major medicines recommended to prevent cardiovascular disease (CVD) vary across countries and income groups, according to research published in The Lancet.

Approximately 20% of cardiovascular deaths occur in individuals with diagnosed CVD; however, these deaths can be avoided if patients have affordable and available access to heart medication. These medications include aspirin, beta blockers, angiotensin-converting enzyme (ACE) inhibitors or angiotensin-II receptor blockers (ARBs), and statins.

“These medicines are not available in a large proportion of communities in low-income and middle-income countries and if available they are not always affordable,” the researchers wrote. “Both low availability and affordability are associated with low use of these medicines. Unless both availability and affordability are improved, their use is likely to remain low in the rest of the world.”

The PURE Study (Prospective Urban Rural Epidemiology) included data on medication availability from pharmacies in 596 communities and 18 countries from 2003 to 2013. Trained interviewers collected data from households and pharmacies, noting whether the medicines were available at the time of the survey and if they were considered affordable if the combined cost was <20% of the household capacity-to-pay.

Among the 18 countries included in the PURE study, 10% used 3 of the recommended medicines and 3% used all 4. All 4 medicines were considered available in 95% of urban communities and 90% of rural communities in high-income countries. However, in low-income countries medicine was available in 25% of urban communities and 3% of rural communities.

The 4 medicines were potentially unaffordable for only 0.14% of households in countries with high-income, but 60% of households in countries with low-income, the researchers estimated. A patient with CVD in a high-income country would need to spend a median of 1% of their household capacity-to-pay to buy all 4 of the CVD medicines, whereas in low-income countries patients who lived in urban areas paid 17% of the household capacity-to-pay, and patients in rural areas paid 49%.

When the researchers analyzed data from 7013 participants who reported a history of CVD, they found that 37% took one medication; 21% took at least two; 10% took at least 3; 3% took all 4; and 30% did not take any medications.

“Overcoming these large treatment gaps will initially need governments to set policies that make key medicines available and affordable, followed by other strategies to enhance their use (eg, improving access to health-care providers, setting local targets for their use, and monitoring use),” the researchers noted.

In countries where all 4 medicines are available and affordable, only 18% of patients in high-income areas and 3% of patients in low-income or middle-income areas actually used them. This suggests that other factors aside from affordability and accessibility may affect medication use and should be further explored.


  1. Khatib R, McKee M, Shannon H et al. Availability and Affordability of Cardiovascular Disease Medicines and Their Effect on Use in High-Income, Middle-Income, and Low-Income countries: An Analysis of the PURE Study Data. Lancet. 2015;doi: 10.1016/S0140-6736(15)00469-9.