Aspirin, Cheap Drugs Not Used Enough to Treat Heart Disease

Encouraging more people to use aspirin and other low-cost medicines would reduce the toll from heart disease and stroke, the leading cause of death worldwide, researchers said.

A seven-year study of more than 150,000 people found that about 60 percent of those with heart disease may not be taking any of the four effective drug types, according to results presented today at the European Society of Cardiology’s conference in Paris. Use of the treatments was low even in countries with well-developed health systems, said the lead researcher, Salim Yusuf of the Population Health Research Institute in Hamilton, Ontario.

“This is a global tragedy,” Yusuf said at a news conference. “There’s no other way to say this. These are inexpensive, widely available drugs.”

Nurses and other health-care workers should be trained to encourage patients to take the drugs, since doctors have failed to do so, he said. Cardiovascular disease may cause 23.6 million deaths annually by 2030, up from 17.1 million in 2004, according to the World Health Organization.

More than 80 percent of deaths occur in lower- and middle-income countries, where people have less access to health services and are more exposed to risks such as poor diets, according to the Geneva-based WHO.

‘Alarming Message’

Researchers looked at anti-platelet drugs such as aspirin, which reduce blood clots, cholesterol-lowering statins, and two types of treatments that lower blood pressure, so-called beta blockers and angiotensin receptor blockers and angiotensin converting enzyme inhibitors. Participants in 628 rural and urban communities completed standardized questionnaires by phone interview, visits to their homes or when they went to a clinic, according to the study, dubbed PURE and published in the medical journal The Lancet.

The study “provides a stark and alarming message,” Anthony Heagerty, a cardiologist from the University of Manchester in England, wrote in an accompanying editorial. “The implication is that a fresh approach to secondary prevention is needed, especially in high-income countries.”

Canada, Sweden and the United Arab Emirates were the three high-income countries considered. Middle-income nations included Brazil, Poland, Turkey, China and South Africa. The poorer countries were India, Pakistan, Bangladesh and Zimbabwe.

Generic Drugs

The study, the largest of its kind to date, according to The Lancet, showed that only a quarter of people suffering from cardiovascular disease used aspirin and other anti-platelet drugs. Use of the other three drug types was even lower, according to the researchers. In low-income countries, fewer than 10 percent of patients used the drugs.

Beta blockers, angiotensin treatments and aspirin are generic medications. As a result, they’re not marketed by pharmaceutical companies as heavily as more profitable patented drugs are.

“That’s not surprising because nobody is making any money of it,” Yusuf said. “We can’t blame the pharma companies. They discovered these drugs, they did the trials. If you have to blame anyone, it is our collective failure as a society to put systems in place.”

Lipitor, a statin sold by Pfizer Inc., is the world’s biggest-selling drug, with $10.7 billion of sales last year. The drug loses patent exclusivity in the U.S. in November.

Governments need to educate doctors and patients about the drugs and work with industry to make sure they’re available, Heagerty wrote.

“Strong action is needed,” he said. “An epidemic of cardiovascular disease is just beginning in many countries that are ill prepared for what is to come.”

Funders for the study included the Population Health Research Institute and the Canadian Institutes of Health Research. Drug companies that contributed included AstraZeneca Plc, Sanofi, Boehringer Ingelheim GmbH, Les Laboratories Servier and GlaxoSmithKline Plc.

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