Cardiovascular disease drugs are often unavailable or unaffordable in many communities around the world, particularly in poorer countries, a recent study suggests.
Four types of medicines are recommended to help prevent deaths from cardiovascular disease: aspirin, beta blockers to control heart rhythm and lower high blood pressure (like atenolol or metoprolol, for example), drugs such as ACE inhibitors to relax blood vessels and improve blood flow (like captopril or enalapril, for instance) and statins to lower cholesterol (such as simvastatin or atorvastatin, or others).
Except for India, all four drugs were available in only 25% of urban areas and 3% of rural communities in low-income countries. In addition, these drugs were potentially unaffordable in 60% of low-income countries outside of India.
To assess how easy it might be for people get to all four medicines, researchers looked at whether local pharmacies stocked all the drugs and, if so, whether the combined cost was less than 20% of household income remaining after basic subsistence needs have been met.
The four medicines were available and affordable in most urban and rural communities in high-income countries, researchers reported in The Lancet.
"The real unaffordability is even worse than what our paper suggests, because it's not just the pills, it is the amount of time off work, the cost to see the doctor, and the transportation cost," said senior author Salim Yusuf, executive director of the Population Health Research Institute and professor at McMaster University in Hamilton, Ontario.
An estimated 17 million people worldwide die of cardiovascular disease each year, noted Yusuf and his colleagues.
The World Health Organisation wants medicines for preventing cardiovascular disease to be available in 80% of communities and used by 50% of eligible individuals by 2025.
To see how the current reality measures up to this goal, the research team analysed data on almost 95,000 households from nearly 600 communities in 18 countries — including about 7,000 people with cardiovascular disease.
In upper-middle-income countries, the four medicines were available in 80% urban and 73% rural communities, the analysis found. But the drugs were unaffordable in 25% of these countries.
For lower-middle-income nations, the drugs were all available in 62% urban and 37% rural areas, but unaffordable in one-third of the countries.
Access was better in India than in a typical low-income country, the study found. Here, the medicines were available in 89% urban and 81% rural communities — and affordable for 59% households.
Louis Niessen and Jahangir Khan, health economists at the Centre for Applied Health Research and Delivery at the Liverpool School of Tropical Medicine in the UK, write in an editorial that the findings highlight a problem that goes far beyond just the accessibility of medicines for cardiovascular disease because families may lose work due to cardiovascular events, or suffer from additional diseases or injuries that are challenging to treat due to the cost or the unavailability of care close to home.
"Our failure to provide healthcare for many leads to a lot of human suffering and loss of important adults in our lives as they die prematurely, up to 10-20 years too early or remain with disability from stroke or from a more classical tropical condition," Niessen said.
