ArticleBMJ global health2020
Availability and affordability of medicines and cardiovascular outcomes in 21 high-income, middle-income and low-income countries.
Article in BMJ global health, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 54 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
54 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Pharmacological lipid-lowering therapies for primary and secondary prevention of cardiovascular disease in adults with dyslipidaemia: a systematic review and network meta-analysis.The Cochrane database of systematic reviews · 2026Pooled it
- Hypertension in Adults With Diabetes in Southeast Asia: A Systematic Review.Journal of clinical hypertension (Greenwich, Conn.) · 2025Pooled it
- Association between Lipid Profile and Apolipoproteins with Risk of Diabetic Foot Ulcer: A Systematic Review and Meta-Analysis.International journal of clinical practice · 2022Pooled it
- Development of a heart failure with preserved ejection fraction risk prediction score in primary care settings with a high HIV prevalence.Open heart · 2026Observational
- Tobacco-Attributable Burden of Early-Onset Ischemic Heart Disease From 1990 to 2023: A Global Analysis Using GBD 2023 and Age-Period-Cohort Modeling.Clinical cardiology · 2026Article
- Local systems, local solutions: which factors drive essential medicine availability in public health facilities across Indonesia?BMJ global health · 2026Article
- Patient Priorities for Coverage of New Antihypertensive Drugs: A Discrete Choice Experiment in China.Patient preference and adherence · 2026Article
- Prevalence, Determinants, and Time Trends of Cardiovascular Health in the WHO African Region.JAMA cardiology · 2025Article
- A window into vision health: quality of life and satisfaction among glaucoma patients.International ophthalmology · 2025Article
- From guidelines to practice: LDL-C achievement in very high cardiovascular risk patients - analysis of the EDHIPO MARCA registry.Lipids in health and disease · 2025Article
- Three-decade analysis of regional disparities in metabolic risk factor related ischemic heart disease mortality: Contrasting trends between South Asia and North America.International journal of cardiology. Cardiovascular risk and prevention · 2025Article
- Social factors, health policy, and environment: implications for cardiovascular disease across the globe.European heart journal · 2025Review
- Tackling the (un)affordability of medicines for cardiometabolic risk factors worldwide: a call to action.BMJ global health · 2025Article
- Global 'side effects' of the EU's pharmaceutical reforms and their impact on access to medicines in LMICs.BMJ global health · 2025Article
- High long-term mortality in ischaemic heart disease accentuated among ethnic minorities in Eastern Europe: findings from a prospective all-comers percutaneous coronary intervention registry in Romania.Journal of epidemiology and community health · 2025Article
- Lived experience of affordability as a barrier to prescription medicines: A longitudinal qualitative study.Exploratory research in clinical and social pharmacy · 2025Article
- WHF Roadmap on Single Pill Combination Therapies.Global heart · 2025Review
- Burden and Predictors of Statin Use for Primary and Secondary Prevention of Cardiovascular Disease in Bangladesh: Evidence from a Nationally Representative Survey.Global heart · 2025Article
- Systematic analysis of the burden of ischemic stroke attributable to high LDL-C from 1990 to 2021.Frontiers in neurology · 2025Article
- EU's Extraterritorial Obligations for Global Medicine Access Under the Convention on the Rights of Persons with Disability (CPRD).The Journal of law, medicine & ethics : a journal of the American Society of Law, Medicine & Ethics · 2025Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
32 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesWe aimed to examine the relationship between access to medicine for cardiovascular disease (CVD) and major adverse cardiovascular events (MACEs) among people at high risk of CVD in high-income countries (HICs), upper and lower middle-income countries (UMICs, LMICs) and low-income countries (LICs) participating in the Prospective Urban Rural Epidemiology (PURE) study.
methodsWe defined high CVD risk as the presence of any of the following: hypertension, coronary artery disease, stroke, smoker, diabetes or age >55 years. Availability and affordability of blood pressure lowering drugs, antiplatelets and statins were obtained from pharmacies. Participants were categorised: group 1-all three drug types were available and affordable, group 2-all three drugs were available but not affordable and group 3-all three drugs were not available. We used multivariable Cox proportional hazard models with nested clustering at country and community levels, adjusting for comorbidities, sociodemographic and economic factors.
resultsOf 163 466 participants, there were 93 200 with high CVD risk from 21 countries (mean age 54.7, 49% female). Of these, 44.9% were from group 1, 29.4% from group 2 and 25.7% from group 3. Compared with participants from group 1, the risk of MACEs was higher among participants in group 2 (HR 1.19, 95% CI 1.07 to 1.31), and among participants from group 3 (HR 1.25, 95% CI 1.08 to 1.50).
conclusionLower availability and affordability of essential CVD medicines were associated with higher risk of MACEs and mortality. Improving access to CVD medicines should be a key part of the strategy to lower CVD globally.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.