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Coca A, Whelton SP, Camafort M, López-López JP, Yang E. Single-pill combination for treatment of hypertension: Just a matter of practicality or is there a real clinical benefit? Eur J Intern Med 2024; 126:16-25. [PMID: 38653633 DOI: 10.1016/j.ejim.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 03/27/2024] [Accepted: 04/16/2024] [Indexed: 04/25/2024]
Abstract
Elevated blood pressure (BP) is the largest contributor to the incident cardiovascular disease worldwide. Despite explicit guideline recommendations for the diagnosis and management of hypertension, a large proportion of patients remain undiagnosed, untreated, or treated but uncontrolled. Inadequate BP control is associated with many complex factors including patient preference, physician's inertia, health systems disparities, and poor adherence to prescribed antihypertensive drug treatment. The primary driver for reduced cardiovascular morbidity and mortality is lowering of BP ''per se'' and not class effects of specific pharmacotherapies. The recent ESH guidelines recommend the use of four major classes of drugs including renin-angiotensin-aldosterone system (RAS) blockers (angiotensin receptor blockers (ARB) or angiotensin-converting enzyme inhibitors (ACEi)), calcium channel blockers (CCB), thiazide and thiazide-like diuretics, and betablockers. Initiation of treatment for hypertension with a two-drug regimen, preferably in a single pill combination (SPC), is recommended for most patients. Preferred combinations should comprise a RAS blocker (either an ACEi or an ARB) with a CCB or thiazide/thiazide-like diuretic. These strategies are supported by robust evidence that combination therapy produces greater BP reductions than monotherapy, reduces side effects of the individual components, improves therapeutic adherence and long-term persistence on treatment, and permits achievement of earlier BP control.
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Affiliation(s)
- A Coca
- Hypertension and Vascular Risk Unit. Department of Internal Medicine. Hospital Clínic, University of Barcelona, Barcelona, Spain.
| | - S P Whelton
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - M Camafort
- Hypertension and Vascular Risk Unit. Department of Internal Medicine. Hospital Clínic (IDIBAPS, CIBER-OBN). University of Barcelona, Barcelona, Spain
| | - J P López-López
- Masira Research Institute, University of Santander (UDES), Bucaramanga, Colombia
| | - E Yang
- Division of Cardiology, University of Washington School of Medicine, Seattle, Washington, USA
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Yang Z, Li X, Song W, Zhang Y. Associations between meeting 24-h movement guidelines and sarcopenia risk among adults aged ≥ 55 years in five low- and middle-income countries. Complement Ther Clin Pract 2024; 57:101887. [PMID: 39084129 DOI: 10.1016/j.ctcp.2024.101887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Revised: 07/09/2024] [Accepted: 07/23/2024] [Indexed: 08/02/2024]
Abstract
OBJECTIVE To diminish the negative influence of sarcopenia on senior adults, the study aimed to investigate the association between adherence to 24-h movement behavior guidelines (physical activity, sedentary behavior, sleep duration) and the risk of sarcopenia among individuals aged ≥55 years in five low- and middle-income countries (LMICs). METHODS A total of 16,503 adults aged ≥55 years were included in this cross-sectional study. The study utilized data from Global Aging and Adult Health Survey (SAGE). Participants reported their information about physical activity, sedentary behavior, and sleep duration using the questionnaire. Sarcopenia was identified as low skeletal muscle mass with a diminished gait speed or weakened handgrip strength. Multiple logistic regression models were used to investigate the association between adherence to 24-h movement behavior guidelines and the risk of sarcopenia. RESULTS Merely 32.73 % of participants met all three 24-h movement behavior guidelines (physical activity, less sedentary behavior, sleep). Meeting all three guidelines (p < 0.01) was significantly associated with a lower risk of sarcopenia. Meeting physical activity only (p < 0.05), or meeting both physical activity and sedentary behaivor (p < 0.05), or meeting both physical activity and sleep duration (p < 0.01) guidelines were also associated with a reduced risk of sarcopenia. Moreover, adults aged 65+ years who adhered to 24-h movement behavior guidelines exhibited a significantly reduced risk of developing sarcopenia. CONCLUSION The findings suggest that the adherence to 24-h movement behavior guidelines for regular physical activity, limited sedentary behavior, and sufficient sleep duration was associated with a reduced risk of sarcopenia in adults aged ≥55 years in five LMICs.
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Affiliation(s)
- Ziyi Yang
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, 518172, China; Physical Activity and Health Promotion Laboratory, The Chinese University of Hong Kong, Shenzhen, 518172, China
| | - Xinxing Li
- Department of Physical Education, Seoul National University, Seoul, 08826, South Korea; Institute on Aging, Seoul National University, Seoul, 08826, South Korea.
| | - Wook Song
- Department of Physical Education, Seoul National University, Seoul, 08826, South Korea; Institute on Aging, Seoul National University, Seoul, 08826, South Korea; Institute of Sport Science, Seoul National University, 08826, Seoul Korea
| | - Yanjie Zhang
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, 518172, China; Physical Activity and Health Promotion Laboratory, The Chinese University of Hong Kong, Shenzhen, 518172, China.
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Mansfield BS, Mohamed F, Larouche M, Raal FJ. The Hurdle of Access to Emerging Therapies and Potential Solutions in the Management of Dyslipidemias. J Clin Med 2024; 13:4160. [PMID: 39064199 PMCID: PMC11277596 DOI: 10.3390/jcm13144160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 07/04/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
This review explores the many barriers to accessing lipid-lowering therapies (LLTs) for the prevention and management of atherosclerotic cardiovascular disease (ASCVD). Geographical, knowledge, and regulatory barriers significantly impede access to LLTs, exacerbating disparities in healthcare infrastructure and affordability. We highlight the importance of policy reforms, including pricing regulations and reimbursement policies, for enhancing affordability and streamlining regulatory processes. Innovative funding models, such as value-based pricing and outcome-based payment arrangements, have been recommended to make novel LLTs more accessible. Public health interventions, including community-based programs and telemedicine, can be utilized to reach underserved populations and improve medication adherence. Education and advocacy initiatives led by patient advocacy groups and healthcare providers play a crucial role in raising awareness and empowering patients. Despite the barriers to access, novel LLTs present a big opportunity to reduce the burden of ASCVD, emphasizing the need for collaborative efforts among policymakers, healthcare providers, industry stakeholders, and patient advocacy groups to address these barriers to improve access to LLTs globally.
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Affiliation(s)
- Brett S. Mansfield
- Department of Internal Medicine, University of the Witwatersrand, Johannesburg 2193, South Africa; (B.S.M.); (F.M.)
- Carbohydrate & Lipid Metabolism Research Unit, University of the Witwatersrand, Johannesburg 2193, South Africa
| | - Farzahna Mohamed
- Department of Internal Medicine, University of the Witwatersrand, Johannesburg 2193, South Africa; (B.S.M.); (F.M.)
- Carbohydrate & Lipid Metabolism Research Unit, University of the Witwatersrand, Johannesburg 2193, South Africa
| | - Miriam Larouche
- Département de Médecine, Université de Montréal and ECOGENE-21, Montreal, QC H3T 1J4, Canada;
| | - Frederick J. Raal
- Department of Internal Medicine, University of the Witwatersrand, Johannesburg 2193, South Africa; (B.S.M.); (F.M.)
- Carbohydrate & Lipid Metabolism Research Unit, University of the Witwatersrand, Johannesburg 2193, South Africa
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Antony Sheron V, Gooden TE, Uruthirakumar P, Shribavan K, Guruparan M, Subaschandren K, Lip GYH, Nirantharakumar K, Thomas GN, Surenthirakumaran R, Kumarendran B, Manaseki-Holland S. The pathway to diagnosis and follow-up care for atrial fibrillation in Sri Lanka: a descriptive longitudinal study. NIHR OPEN RESEARCH 2024; 3:63. [PMID: 39139280 PMCID: PMC11320028 DOI: 10.3310/nihropenres.13497.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/30/2024] [Indexed: 08/15/2024]
Abstract
Background Early diagnosis and continuity of care is vital for atrial fibrillation (AF), to reduce stroke ; There is a lack of understanding of when and how AF is being diagnosed and managed the care pathway) in in low- and middle-income countries (LMICs). We aimed to identify the AF care pathway in Northern Province, Sri Lanka and determine how the COVID-19 pandemic impacted the care pathway. Methods This descriptive longitudinal study utilised two quantitative questionnaires to evaluate the AF pathway: The first questionnaire (baseline) was used to identify where AF was being diagnosed and the second questionnaire (3 months following baseline) was used to identify where and how often AF follow-up care was being received. How the COVID-19 pandemic impacted the care pathway was asked in the second questionnaire. We aimed to recruit 236 adults (≥18 years) with AF from Jaffna Teaching Hospital. Data were collected between October 2020 and June 2021 and analysed using descriptive statistics. Results 151 participants were recruited (median age 57 years; 70% female). Most participants were diagnosed in the accident & emergency (38%) or inpatient department (26%), followed by an outpatient department (19%) or private facility (16%). Nearly all (97%) participants received follow-up care during the study period, with an average of 1.3 AF-related healthcare visits per person for a month; most visited an outpatient department (88%). The COVID-19 pandemic negatively impacted 39% of participants' care: healthcare visits were reduced or, delayed or medications were unattainable, and longer intervals between blood tests were experienced; however, 24% of participants were able to receive their medication by ambulance, public health staff or post during lockdowns. Conclusions Primary care was not involved in the diagnosis of AF, indicating that most diagnoses occurr after a medical emergency. The frequency of blood tests was lower than the guideline recommendations of one per month which could in-part be due to the adverse impacts of the pandemic. Strengthening primary and community-based care may enable early diagnosis and improve continuity of care during and beyond future healthcare crises.
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Affiliation(s)
- Vethanayagam Antony Sheron
- Department of Community and Family Medicine, Faculty of Medicine, University of Jaffna, Jaffna, Northern Province, 40000, Sri Lanka
| | - Tiffany E. Gooden
- Institute of Applied Health Research, University of Birmingham, Birmingham, England, B15 2TT, UK
| | - Powsiga Uruthirakumar
- Department of Community and Family Medicine, Faculty of Medicine, University of Jaffna, Jaffna, Northern Province, 40000, Sri Lanka
| | - Kanesamoorthy Shribavan
- Department of Community and Family Medicine, Faculty of Medicine, University of Jaffna, Jaffna, Northern Province, 40000, Sri Lanka
| | - Mahesan Guruparan
- Department of Cardiology, Teaching Hospital Jaffna, University of Jaffna, Jaffna, Northern Province, 40000, Sri Lanka
| | - Kumaran Subaschandren
- Department of Community and Family Medicine, Faculty of Medicine, University of Jaffna, Jaffna, Northern Province, 40000, Sri Lanka
| | - Gregory Y. H. Lip
- Institute of Applied Health Research, University of Birmingham, Birmingham, England, B15 2TT, UK
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University, Liverpool, England, L2 2QP, UK
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg Universitet, Aalborg, North Denmark Region, DK - 9100, Denmark
| | | | - G. Neil Thomas
- Institute of Applied Health Research, University of Birmingham, Birmingham, England, B15 2TT, UK
| | - Rajendra Surenthirakumaran
- Department of Community and Family Medicine, Faculty of Medicine, University of Jaffna, Jaffna, Northern Province, 40000, Sri Lanka
| | - Balachandran Kumarendran
- Department of Community and Family Medicine, Faculty of Medicine, University of Jaffna, Jaffna, Northern Province, 40000, Sri Lanka
- Institute of Applied Health Research, University of Birmingham, Birmingham, England, B15 2TT, UK
| | - Semira Manaseki-Holland
- Institute of Applied Health Research, University of Birmingham, Birmingham, England, B15 2TT, UK
| | - NIHR Global Health Research Group on Atrial Fibrillation Management
- Department of Community and Family Medicine, Faculty of Medicine, University of Jaffna, Jaffna, Northern Province, 40000, Sri Lanka
- Institute of Applied Health Research, University of Birmingham, Birmingham, England, B15 2TT, UK
- Department of Cardiology, Teaching Hospital Jaffna, University of Jaffna, Jaffna, Northern Province, 40000, Sri Lanka
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University, Liverpool, England, L2 2QP, UK
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg Universitet, Aalborg, North Denmark Region, DK - 9100, Denmark
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Li M, Li Y, Liu Z, Hystad P, Rangarajan S, Tse LA, Lear SA, Ma Y, Chen M, Han G, Li R, Yusuf S, Liu L, Hu B, Li W. Associations of perceived built environment characteristics using NEWS questionnaires with all-cause mortality and major cardiovascular diseases: The prospective urban rural epidemiology (PURE)-China study. ENVIRONMENT INTERNATIONAL 2024; 187:108627. [PMID: 38636273 DOI: 10.1016/j.envint.2024.108627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 03/31/2024] [Accepted: 04/02/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Despite increased literature focusing on the role of the built environment (BE) in health, few cohort studies have quantitatively analyzed neighborhood walkability environment in relation to the risk of death and cardiovascular disease (CVD). This longitudinal study aimed at evaluating the association between perceived BE attributeswith mortality and major CVD based on the Prospective Urban Rural Epidemiology study in China (PURE-China). METHODS The PURE-China study recruited 47,931 participants aged 35-70 years from 12 provinces of China between 2005 and 2009. The perceived BE information, including land use, street, aesthetics, and safety, was collected using the neighborhood environment walkability scale (NEWS) questionnaire, with higher scores indicating a more favorable rating. Two primary outcomes are all-cause mortality and major CVD event. The Cox frailty model with random intercepts was used to assess the association between the perceived total BE/subscales score and outcomes. RESULTS Of 32,163 participants included in this study, 19,253 (59.9 %) were women, and the mean (SD) age was 51.0 (9.5) years. After a median follow-up period of 11.7 years (IQR 9.4 - 12.2), we observed that one standard deviation higher of combined BE scores was related to a lower risk of all-cause mortality (HR = 0.85; 95 %CI, 0.80-0.90), and major CVD events (HR = 0.95; 95 %CI, 0.90-0.99). The subscales of perceived BE were related to a lower risk, although a few were not significant. Land use mix-diversity and safety from crime were the two most significant subscales. Stronger risks were observed among urban and female participants. CONCLUSION Favorable perceived BE characteristics were linked with a lower risk of all-cause mortality and major CVD events in Chinese population, especially in urban areas and females. Our findings can be used by policymakers to take action to mitigate the adverse effect of poor community conditions on health, such as improving local amenities and transport connectivity, providing building paths for walking, running and cycling.
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Affiliation(s)
- Mengya Li
- Medical Research & Biometrics Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences Beijing, China
| | - Yang Li
- Medical Research & Biometrics Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences Beijing, China; Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zhiguang Liu
- Clinical Trial Unit, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Perry Hystad
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, United States
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Lap Ah Tse
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR
| | - Scott A Lear
- Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
| | - Yuanting Ma
- Dongguan Street Community Health Service Center, Xining, Qinghai Province, China
| | - Mengxin Chen
- Medical Research & Biometrics Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences Beijing, China
| | - Guoliang Han
- Medical Research & Biometrics Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences Beijing, China
| | - Ruotong Li
- Medical Research & Biometrics Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences Beijing, China
| | - Salim Yusuf
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Lisheng Liu
- Beijing Hypertension League Institute, Beijing, China.
| | - Bo Hu
- Medical Research & Biometrics Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences Beijing, China.
| | - Wei Li
- Medical Research & Biometrics Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences Beijing, China.
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Zhang J, Zhu S, Liu C, Hu Y, Yang A, Zhang Y, Hong Y. Global, regional and national burden of ischemic stroke attributed to high low-density lipoprotein cholesterol, 1990-2019:A decomposition analysis and age-period-cohort analysis. J Cereb Blood Flow Metab 2024; 44:527-541. [PMID: 37891501 PMCID: PMC10981397 DOI: 10.1177/0271678x231211448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/11/2023] [Accepted: 10/15/2023] [Indexed: 10/29/2023]
Abstract
High levels of low-density lipoprotein cholesterol (LDL-C) have been associated with an augmented mortality of ischemic stroke. The yearly deaths and mortality data of IS-hLDL-C were derived from the global burden of disease 2019 dataset. The joinpoint, age-period-cohort and decomposition analysis were utilized to evaluate the long-term patterns in the disease burden of IS-hLDL-C, and the effects of population growth and aging. Globally, in 2019, 0.61 million ischemic stroke-related deaths were attributable to high LDL-C, with the highest death burden in the high-middle socio-demographic index (SDI) region. From 1990 to 2019, the age-standardized death rate (ASDR) for IS-hLDL-C exhibited a downward trend, with an average annual percentage change of -1.69 [95% confidence interval: -1.90, -1.48)]. The fastest decreasing trends in ASDR were experienced in the high SDI region. In 119 (58.33%) countries, aging increased the disease burden of hLDL-IS, and population growth increased the disease burden of IS-hLDL-C in 163 (79.90%) countries. The trend in disease burden of IS-hLDL-C exhibited variation across countries and regions, particularly in territories with high to middle high SDI. Aging in upper to middle-income countries and population growth in low to middle-income countries further offset endeavors to reduce the burden of ischemic stroke deaths.
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Affiliation(s)
- Jian Zhang
- Department of Neurosurgery, Shengjing Hospital, China Medical University, Shenyang, China
- Department of Neurosurgery, the Seventh Clinical College of China Medical University, Fushun, China
| | - Shijie Zhu
- Department of Occupational and Environmental Health, School of Public Health, Wuhan University, Wuhan, China
| | - Chunlong Liu
- Department of Hepatobiliary and Pancreatic Surgery, Fuyang People's Hospital, Anhui Medical University, Fuyang, China
| | - Yaofeng Hu
- Department of Neurosurgery, Shengjing Hospital, China Medical University, Shenyang, China
| | - Aoran Yang
- Department of Neurosurgery, Shengjing Hospital, China Medical University, Shenyang, China
| | - Yonghui Zhang
- Department of Neurosurgery, the Seventh Clinical College of China Medical University, Fushun, China
| | - Yang Hong
- Department of Neurosurgery, Shengjing Hospital, China Medical University, Shenyang, China
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Diallo AO, Marcus ME, Flood D, Theilmann M, Rahim NE, Kinlaw A, Franceschini N, Stürmer T, Tien DV, Abbasi-Kangevari M, Agoudavi K, Andall-Brereton G, Aryal K, Bahendeka S, Bicaba B, Bovet P, Dorobantu M, Farzadfar F, Ghamari SH, Gathecha G, Guwatudde D, Gurung M, Houehanou C, Houinato D, Hwalla N, Jorgensen J, Kagaruki G, Karki K, Martins J, Mayige M, McClure RW, Moghaddam SS, Mwalim O, Mwangi KJ, Norov B, Quesnel-Crooks S, Sibai A, Sturua L, Tsabedze L, Wesseh C, Geldsetzer P, Atun R, Vollmer S, Bärnighausen T, Davies J, Ali MK, Seiglie JA, Gower EW, Manne-Goehler J. Multiple cardiovascular risk factor care in 55 low- and middle-income countries: A cross-sectional analysis of nationally-representative, individual-level data from 280,783 adults. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003019. [PMID: 38536787 PMCID: PMC10971750 DOI: 10.1371/journal.pgph.0003019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 02/20/2024] [Indexed: 04/26/2024]
Abstract
The prevalence of multiple age-related cardiovascular disease (CVD) risk factors is high among individuals living in low- and middle-income countries. We described receipt of healthcare services for and management of hypertension and diabetes among individuals living with these conditions using individual-level data from 55 nationally representative population-based surveys (2009-2019) with measured blood pressure (BP) and diabetes biomarker. We restricted our analysis to non-pregnant individuals aged 40-69 years and defined three mutually exclusive groups (i.e., hypertension only, diabetes only, and both hypertension-diabetes) to compare individuals living with concurrent hypertension and diabetes to individuals with each condition separately. We included 90,086 individuals who lived with hypertension only, 11,975 with diabetes only, and 16,228 with hypertension-diabetes. We estimated the percentage of individuals who were aware of their diagnosis, used pharmacological therapy, or achieved appropriate hypertension and diabetes management. A greater percentage of individuals with hypertension-diabetes were fully diagnosed (64.1% [95% CI: 61.8-66.4]) than those with hypertension only (47.4% [45.3-49.6]) or diabetes only (46.7% [44.1-49.2]). Among the hypertension-diabetes group, pharmacological treatment was higher for individual conditions (38.3% [95% CI: 34.8-41.8] using antihypertensive and 42.3% [95% CI: 39.4-45.2] using glucose-lowering medications) than for both conditions jointly (24.6% [95% CI: 22.1-27.2]).The percentage of individuals achieving appropriate management was highest in the hypertension group (17.6% [16.4-18.8]), followed by diabetes (13.3% [10.7-15.8]) and hypertension-diabetes (6.6% [5.4-7.8]) groups. Although health systems in LMICs are reaching a larger share of individuals living with both hypertension and diabetes than those living with just one of these conditions, only seven percent achieved both BP and blood glucose treatment targets. Implementation of cost-effective population-level interventions that shift clinical care paradigm from disease-specific to comprehensive CVD care are urgently needed for all three groups, especially for those with multiple CVD risk factors.
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Affiliation(s)
- Alpha Oumar Diallo
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Maja E. Marcus
- Department of Economics and Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany
| | - David Flood
- University of Michigan, Ann Arbor, Michigan, United States of America
| | - Michaela Theilmann
- Faculty of Medicine and University Hospital, Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Nicholas E. Rahim
- Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Alan Kinlaw
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina School of Pharmacy at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Nora Franceschini
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Til Stürmer
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Dessie V. Tien
- Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Mohsen Abbasi-Kangevari
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Krishna Aryal
- Nepal Health Sector Programme 3, Monitoring Evaluation and Operational Research Project, Abt Associates, Kathmandu, Nepal
| | | | - Brice Bicaba
- Institut Africain de Santé Publique, Ouagadougou, Burkina Faso
| | - Pascal Bovet
- Ministry of Health, Victoria, Seychelles
- University Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - Maria Dorobantu
- Department of Cardiology, Emergency Hospital of Bucharest, Bucharest, Romania
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyyed-Hadi Ghamari
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Gladwell Gathecha
- Division of Non-Communicable Diseases, Ministry of Health, Nairobi, Kenya
| | - David Guwatudde
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | - Mongal Gurung
- Health Research and Epidemiology Unit, Ministry of Health, Thimphu, Bhutan
| | - Corine Houehanou
- Laboratory of Epidemiology of Chronic and Neurological Diseases, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - Dismand Houinato
- Laboratory of Epidemiology of Chronic and Neurological Diseases, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - Nahla Hwalla
- Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Jutta Jorgensen
- Dept of Public Health and Epidemiology, Institute of Global Health, Copenhagen University, Copenhagen, Denmark
| | - Gibson Kagaruki
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Khem Karki
- Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Joao Martins
- Faculty of Medicine and Health Sciences, Universidade Nacional Timor Lorosa’e, Dili, Timor-Leste
| | - Mary Mayige
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Roy Wong McClure
- Office of Epidemiology and Surveillance, Costa Rican Social Security Fund, San José, Costa Rica
| | - Sahar Saeedi Moghaddam
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Bolormaa Norov
- Nutrition Department, National Center for Public Health, Ulaanbaatar, Mongolia
| | | | - Abla Sibai
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Lela Sturua
- Non-Communicable Disease Department, National Center for Disease Control and Public Health, Tbilisi, Georgia
| | | | | | - Pascal Geldsetzer
- Faculty of Medicine and University Hospital, Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- Division of Primary Care and Population Health, Stanford University, Stanford, California, United States of America
| | - Rifat Atun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
- Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, Massachusetts, United States of America
| | - Sebastian Vollmer
- Department of Economics and Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany
| | - Till Bärnighausen
- Faculty of Medicine and University Hospital, Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
- Africa Health Research Institute, Somkhele, South Africa
| | - Justine Davies
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Mohammed K. Ali
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | | | - Emily W. Gower
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Department of Ophthalmology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Jennifer Manne-Goehler
- Department of Economics and Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany
- Division of Infectious Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
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8
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Wu W, Pan Y, Zheng T, Sun H, Li X, Zhu H, Wang Z, Zhou X. Limonin alleviates high-fat diet-induced dyslipidemia by regulating the intestinal barrier via the microbiota-related ILC3-IL22-IL22R pathway. Food Funct 2024; 15:2679-2692. [PMID: 38375746 DOI: 10.1039/d3fo04530g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
High-fat diet (HFD)-induced dyslipidemia is frequently accompanied by gut microbiota dysbiosis and a compromised gut barrier. Enhancing the intestinal barrier function emerges as a potential therapeutic approach for dyslipidemia. The ILC3-IL22-IL22R pathway, which responds to dietary and microbial signals, has not only attracted attention for its crucial role in maintaining the intestinal barrier, but recent reports have also suggested its potential in regulating lipid metabolism. Limonin is derived from the Chinese herb Evodiae fructus, which has shown potential in ameliorating dysbiosis of serum lipids. However, its underlying mechanisms remain elusive. Consequently, targeting the ILC3-IL22-IL22R pathway to enhance intestinal barrier function holds promise as a therapeutic approach for dyslipidemia. In this study, male C57BL/6 mice were subjected to a 16-week HFD to induce dyslipidemia and concurrently administered oral limonin. We discovered that limonin supplementation dramatically reduced serum lipid profiles in HFD-fed mice, significantly curbing HFD-induced weight gain and epididymal fat accumulation. Ileal histopathological evaluation indicated limonin's ameliorative effects on HFD-induced intestinal barrier impairment. Limonin also moderated the intestinal microbiota dysbiosis, which is characterized by the elevation of Firmicutes in HFD mice, and notably amplified the abundance of probiotic Lactobacillus. In addition, supported by flow cytometry and other analyses, we observed that limonin upregulated the ILC3-IL22-IL22R pathway, enhancing phosphorylated STAT3 (pSTAT3) in intestinal epithelial cells (IECs), thereby reducing lipid transporter expression. In conclusion, our study revealed that limonin exerted a promising preventive effect against HFD-induced dyslipidemia by the mitigation of the intestinal barrier function and intestinal microbiota, and its mechanism was related to the upregulation of the ILC3-IL22-IL22R pathway.
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Affiliation(s)
- Wangling Wu
- School of Basic Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China.
| | - Yingying Pan
- School of Basic Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China.
| | - Tianyan Zheng
- School of Basic Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China.
| | - Haoyi Sun
- School of Basic Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China.
| | - Xia Li
- School of Basic Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China.
| | - Haiyan Zhu
- School of Basic Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China.
| | - Zheng Wang
- School of Basic Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China.
| | - Xin Zhou
- School of Basic Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China.
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9
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Hu M, Li B, Yang T, Yang Y, Yin C. Effect of Household Income on Cardiovascular Diseases, Cardiovascular Biomarkers, and Socioeconomic Factors. Clin Ther 2024; 46:239-245. [PMID: 38350757 DOI: 10.1016/j.clinthera.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/07/2023] [Accepted: 01/08/2024] [Indexed: 02/15/2024]
Abstract
PURPOSE To examine whether household income is causally related to cardiovascular diseases and investigate the potential reasons. METHODS Using 2-sample Mendelian randomization analyses, we obtained summary statistics from genome-wide association studies of household income and a range of cardiovascular diseases, biomarkers, and socioeconomic factors. FINDINGS Higher household income was causally associated with lower risks of coronary heart disease (odd ratio [OR] = 0.63; 95% CI: 0.49-0.79; P = 0.0001), myocardial infarction (OR = 0.64; 95% CI: 0.50-0.82; P = 0.0003), and hypertension (OR = 0.71; 95% CI: 0.58-0.88; P = 0.0015). With increasing household income, the cardiovascular biomarkers including triglycerides, C-reactive protein, body mass index, fasting glucose were decreased whereas telomere length and high-density lipoprotein cholesterol were increased. Besides, individuals with higher household income were less likely to smoke (β = -0.34; 95% CI: -0.47 to -0.21; P = 1.91×10-07), intake salt (β = -0.14; 95% CI: -0.21 to -0.07; P = 0.0001), or be exposed to air pollution (β = -0.10; 95% CI: -0.15 to -0.06; P = 8.81×10-06) or depression state (β = -0.03; 95% CI: -0.04 to -0.02; P = 5.16×10-07). They were more likely to take physical activity (β = 0.06; 95% CI: 0.02 to 010; P = 0.0016) and have long years of schooling (β = 0.70; 95% CI: 0.62 to 0.78; P = 5.32×10-67). IMPLICATIONS Higher household income is causally associated with better socioeconomic factors and improved cardiovascular biomarkers, which translates into a reduced prevalence of cardiovascular diseases. Policies to improve income equality may result in a reduced burden of cardiovascular diseases.
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Affiliation(s)
- Mengjin Hu
- Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Boyu Li
- Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Tao Yang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yuejin Yang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Chunlin Yin
- Xuanwu Hospital, Capital Medical University, Beijing, China.
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10
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Stein DT, Reitsma MB, Geldsetzer P, Agoudavi K, Aryal KK, Bahendeka S, Brant LCC, Farzadfar F, Gurung MS, Guwatudde D, Houehanou YCN, Malta DC, Martins JS, Saeedi Moghaddam S, Mwangi KJ, Norov B, Sturua L, Zhumadilov Z, Bärnighausen T, Davies JI, Flood D, Marcus ME, Theilmann M, Vollmer S, Manne-Goehler J, Atun R, Sudharsanan N, Verguet S. Hypertension care cascades and reducing inequities in cardiovascular disease in low- and middle-income countries. Nat Med 2024; 30:414-423. [PMID: 38278990 DOI: 10.1038/s41591-023-02769-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 12/15/2023] [Indexed: 01/28/2024]
Abstract
Improving hypertension control in low- and middle-income countries has uncertain implications across socioeconomic groups. In this study, we simulated improvements in the hypertension care cascade and evaluated the distributional benefits across wealth quintiles in 44 low- and middle-income countries using individual-level data from nationally representative, cross-sectional surveys. We raised diagnosis (diagnosis scenario) and treatment (treatment scenario) levels for all wealth quintiles to match the best-performing country quintile and estimated the change in 10-year cardiovascular disease (CVD) risk of individuals initiated on treatment. We observed greater health benefits among bottom wealth quintiles in middle-income countries and in countries with larger baseline disparities in hypertension management. Lower-middle-income countries would see the greatest absolute benefits among the bottom quintiles under the treatment scenario (29.1 CVD cases averted per 1,000 people living with hypertension in the bottom quintile (Q1) versus 17.2 in the top quintile (Q5)), and the proportion of total CVD cases averted would be largest among the lowest quintiles in upper-middle-income countries under both diagnosis (32.0% of averted cases in Q1 versus 11.9% in Q5) and treatment (29.7% of averted cases in Q1 versus 14.0% in Q5) scenarios. Targeted improvements in hypertension diagnosis and treatment could substantially reduce socioeconomic-based inequalities in CVD burden in low- and middle-income countries.
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Affiliation(s)
- Dorit Talia Stein
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Marissa B Reitsma
- Department of Health Policy, Stanford School of Medicine, Stanford University, Stanford, CA, USA
| | - Pascal Geldsetzer
- Division of Primary Care and Population Health, Stanford University, Stanford, CA, USA
- Chan Zuckerberg Biohub, San Francisco, CA, USA
| | - Kokou Agoudavi
- Noncommunicable Disease Program, Ministry of Health, Lomé, Togo
| | - Krishna Kumar Aryal
- Bergen Centre for Ethics and Priority Setting in Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Public Health Promotion and Development Organization, Kathmandu, Nepal
| | - Silver Bahendeka
- MKPGMS-Uganda Martyrs University, Kampala, Uganda
- St. Francis Hospital, Nsambya, Kampala, Uganda
| | - Luisa C C Brant
- Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - David Guwatudde
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | | | - Deborah Carvalho Malta
- Department Maternal Child and Public Health, Nursing School, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - João Soares Martins
- Faculty of Medicine and Health Sciences, Universidade Nacional Timor Lorosa'e, Díli, Timor-Leste
| | - Sahar Saeedi Moghaddam
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Kiel Institute for the World Economy, Kiel, Germany
| | - Kibachio Joseph Mwangi
- World Health Organization, Pretoria, South Africa
- Division of Non-Communicable Diseases, Ministry of Health, Nairobi, Kenya
| | - Bolormaa Norov
- Nutrition Department, National Center for Public Health, Ulaanbaatar, Mongolia
| | - Lela Sturua
- National Center for Disease Control and Public Health, Tbilisi, Georgia
- Petre Shotadze Tbilisi Medical Academy, Tbilisi, Georgia
| | | | - Till Bärnighausen
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Harvard Center for Population and Development Studies, Cambridge, MA, USA
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Justine I Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Department of Global Health, Centre for Global Surgery, Stellenbosch University, Cape Town, South Africa
| | - David Flood
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Center for Indigenous Health Research, Wuqu' Kawoq, Tecpán, Guatemala
| | - Maja E Marcus
- Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Michaela Theilmann
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Professorship of Behavioral Science for Disease Prevention and Health Care, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Sebastian Vollmer
- Department of Economics & Centre for Modern Indian Studies, University of Göttingen, Göttingen, Germany
| | - Jennifer Manne-Goehler
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA
- Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Rifat Atun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Nikkil Sudharsanan
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Professorship of Behavioral Science for Disease Prevention and Health Care, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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11
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Lane J, Nakambale H, Kadakia A, Dambisya Y, Stergachis A, Odoch WD. A systematic scoping review of medicine availability and affordability in Africa. BMC Health Serv Res 2024; 24:91. [PMID: 38233851 PMCID: PMC10792840 DOI: 10.1186/s12913-023-10494-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 12/18/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND The most recent World Medicines Situation Report published in 2011 found substantial medicine availability and affordability challenges across WHO regions, including Africa. Since publication of the 2011 report, medicine availability and affordability has risen on the international agenda and was included in the Sustainable Development Goals as Target 3.8. While numerous medicine availability and affordability studies have been conducted in Africa since the last World Medicines Situation Report, there has not been a systematic analysis of the methods used in these studies, measures of medicine availability and affordability, categories of medicines studied, or geographic distribution. Filling this knowledge gap can help inform future medicine availability and affordability studies, design systems to monitor progress toward Sustainable Development Goal Target 3.8 in Africa and beyond, and inform policy and program decisions to improve medicine availability and affordability. METHODS We conducted a systematic scoping review of studies assessing medicine availability or affordability conducted in the WHO Africa region published from 2009-2021. RESULTS Two hundred forty one articles met our eligibility criteria. 88% of the articles (213/241) reported descriptive studies, while 12% (28/241) reported interventional studies. Of the 198 studies measuring medicine availability, the most commonly used measure of medicine availability was whether a medicine was in stock on the date of a survey (124/198, 63%). We also identified multiple other availability methods and measures, including retrospective stock record reviews and self-reported medicine availability surveys. Of the 59 articles that included affordability measures, 32 (54%) compared the price of the medicine to the daily wage of the lowest paid government worker. Other affordability measures were patient self-reported affordability, capacity to pay measures, and comparing medicines prices with a population-level income standard (such as minimum wage, poverty line, or per capita income). The most commonly studied medicines were antiparasitic and anti-bacterial medicines. We did not identify studies in 22 out of 48 (46%) countries in the WHO Africa Region and more than half of the studies identified were conducted in Ethiopia, Kenya, Tanzania, and/or Uganda. CONCLUSION Our results revealed a wide range of medicine availability and affordability assessment methodologies and measures, including cross-sectional facility surveys, population surveys, and retrospective data analyses. Our review also indicated a need for greater focus on medicines for certain non-communicable diseases, greater geographic diversity of studies, and the need for more intervention studies to identify approaches to improve access to medicines in the region.
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Affiliation(s)
- Jeff Lane
- Department of Global Health, School of Public Health, University of Washington, Seattle, WA, USA.
| | - Hilma Nakambale
- Department of Global Health, School of Public Health, University of Washington, Seattle, WA, USA
| | - Asha Kadakia
- Department of Global Health, School of Public Health, University of Washington, Seattle, WA, USA
| | - Yoswa Dambisya
- East Central and Southern Africa Health Community, Arusha, Tanzania
| | - Andy Stergachis
- Departments of Pharmacy and Global Health, Schools of Pharmacy and Public Health, University of Washington, Seattle, WA, USA
| | - Walter Denis Odoch
- Afya Research and Development Institute, Kampala, Uganda
- World Health Organization, Harare, Zimbabwe
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12
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Gooden TE, Wang J, Carvalho Goulart A, Varella AC, Tai M, Sheron VA, Wang H, Zhang H, Zhong J, Kumarendran B, Nirantharakumar K, Surenthirakumaran R, Bensenor IM, Guo Y, Lip GYH, Thomas GN, Manaseki-Holland S. Generalisability of and lessons learned from a mixed-methods study conducted in three low- and middle-income countries to identify care pathways for atrial fibrillation. Glob Health Action 2023; 16:2231763. [PMID: 37466418 PMCID: PMC10360996 DOI: 10.1080/16549716.2023.2231763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 06/27/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Identifying existing care pathways is the first step for understanding how services can be improved to enable early diagnosis and effective follow-up care for non-communicable diseases (NCDs); however, evidence on how care pathways can and should be identified in low- and middle-income countries (LMICs) is lacking. OBJECTIVE To describe generalisability and lessons learned from recruitment and data collection for the quantitative component of a mixed methods study designed to determine the care pathway for atrial fibrillation (AF) in Brazil, China and Sri Lanka. METHODS Adults (≥18 years) that spoke the local language and with an AF diagnosis were eligible. We excluded anyone with a hearing or cognitive impairment or ineligible address. Eligible participants were identified using electronic records in Brazil and China; in Sri Lanka, researchers attended the outpatient clinics to identify eligible participants. Data were collected using two quantitative questionnaires administered at least 2-months apart. A minimum sample size of 238 was required for each country. RESULTS The required sample size was met in Brazil (n = 267) and China (n = 298), but a large proportion of AF patients could not be contacted (47% and 27%, respectively) or refused to participate (36% and 38%, respectively). In Sri Lanka, recruitment was challenging, resulting in a reduced sample (n = 151). Mean age of participants from Brazil, China and Sri Lanka was 69 (SD = 11.3), 65 (SD = 12.8) and 58 (SD = 11.7), respectively. Females accounted for 49% of the Brazil sample, 62% in China and 70% in Sri Lanka. CONCLUSIONS Generalisability was an issue in Brazil and China, as was selection bias. Recruitment bias was highlighted in Sri Lanka. Additional or alternative recruitment methods may be required to ensure generalisability and reduce bias in future studies aimed at identifying NCD care pathways in LMICs.
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Affiliation(s)
- Tiffany E Gooden
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jingya Wang
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Alessandra Carvalho Goulart
- Faculdade de Medicina, Universidade, Sao Paulo, São Paulo, Brazil
- Center for Clinical and Epidemiologic Research and Division of Internal Medicine, University Hospital, University of São Paulo, São Paulo, Brazil
| | - Ana C Varella
- Faculdade de Medicina, Universidade, Sao Paulo, São Paulo, Brazil
| | - Meihui Tai
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Vethanayagan Antony Sheron
- Department of Community and Family Medicine, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka
| | - Hao Wang
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Hui Zhang
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Jiaoyue Zhong
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Balachandran Kumarendran
- Department of Community and Family Medicine, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka
| | | | - Rajendra Surenthirakumaran
- Department of Community and Family Medicine, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka
| | - Isabela M Bensenor
- Faculdade de Medicina, Universidade, Sao Paulo, São Paulo, Brazil
- Center for Clinical and Epidemiologic Research and Division of Internal Medicine, University Hospital, University of São Paulo, São Paulo, Brazil
| | - Yutao Guo
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK
| | - G Neil Thomas
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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13
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Yin X, Li M, Wang Y, Zhao G, Yang T, Zhang Y, Guo J, Meng T, Du R, Li H, Wang Z, Zhang J, He Q. Herbal medicine formula Huazhuo Tiaozhi granule ameliorates dyslipidaemia via regulating histone lactylation and miR-155-5p biogenesis. Clin Epigenetics 2023; 15:175. [PMID: 37919786 PMCID: PMC10623728 DOI: 10.1186/s13148-023-01573-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/26/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Huazhuo Tiaozhi granule (HTG) is a herbal medicine formula widely used in clinical practice for hypolipidaemic effects. However, the molecular mechanisms underlying dyslipidaemia treatment have not been well elucidated. RESULTS A significant reduction in the levels of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) was observed in the serum of patients with dyslipidaemia after HTG treatment, without disruption in the levels of aspartate transaminase (AST), alanine transaminase (ALT), urea nitrogen (BUN), and creatinine (Cr). The dyslipidaemia rat model was induced by a high-fat diet and treated with Xuezhikang (0.14 g/kg/d) or HTG (9.33 g crude herb/kg/day) by gavage for 8 weeks. Body weight and liver index were markedly decreased in dyslipidaemic rats after treatment with Xuezhikang or HTG. HTG administration markedly ameliorated hyperlipidaemia by decreasing the levels of TC and LDL-C in serum and hepatic lipid accumulation. In vitro, lipid accumulation in LO2 and HepG2 cells was alleviated by serum treatment with HTG. High lactylation was observed in 198 proteins, including lactylation of histone H2B (K6), H4 (K80). Deep sequencing of microRNAs showed that miR-155-5p was significantly downregulated. CONCLUSIONS This study demonstrates that HTG is an effective and safe formula for treating dyslipidaemia, which promotes lactylation in hepatocytes, and the retardation of miR-155-5p biogenesis.
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Affiliation(s)
- Xiangjun Yin
- School of Basic Medical Science, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Min Li
- Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100032, China
| | - Yongzhi Wang
- Shanghai Key Laboratory of New Drug Design, School of Pharmacy, East China University of Science and Technology, Shanghai, 200237, China
| | - Guifang Zhao
- Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100032, China
| | - Tao Yang
- Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100032, China
| | - Yuqing Zhang
- Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100032, China
| | - Jianbo Guo
- LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong, China
| | - Tiantian Meng
- Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100032, China
| | - Ruolin Du
- Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100032, China
| | - Honglin Li
- Shanghai Key Laboratory of New Drug Design, School of Pharmacy, East China University of Science and Technology, Shanghai, 200237, China.
| | - Zhe Wang
- Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100032, China.
| | - Jian Zhang
- Shanghai Key Laboratory of New Drug Design, School of Pharmacy, East China University of Science and Technology, Shanghai, 200237, China.
| | - Qingyong He
- Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100032, China.
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14
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Mitkova Z, Manev I, Tachkov K, Boyadzhieva V, Stoilov N, Doneva M, Petrova G. How Managed Entry Agreements Influence the Patients' Affordability to Biological Medicines-Bulgarian Example. Healthcare (Basel) 2023; 11:2427. [PMID: 37685461 PMCID: PMC10486911 DOI: 10.3390/healthcare11172427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 08/18/2023] [Accepted: 08/28/2023] [Indexed: 09/10/2023] Open
Abstract
Managed entry agreements are applied in almost all European countries in order to improve patients' access to therapy. The current study aims to evaluate the changes in the affordability of biological medicines for patients in Bulgaria during 2019-2022. The study is a top-down macroeconomic analysis of the key economic indicators and reimbursed costs of biologic therapies. Affordability was determined as the number of working hours needed to pay for monthly therapy. The average NHIF budget for pharmaceuticals increased significantly along with inflation in the healthcare sector. Bulgarian patients had to devote a large part of their income to buying medicines if a co-payment existed. The percentage of the monthly income of pensioners needed for therapy co-payment varied between 10% and 280%. The hours of work required to purchase a package of biologicals varied between 7 and 137 working hours. The global economic crisis has affected Bulgaria and led to worsening economic parameters. There are still no well-established practices to control public spending, as the measures taken to reduce the final cost of medicines mainly affect the pharmaceutical companies. This type of cost-containment policy provides an opportunity for innovative treatment with biologicals for patients with inflammatory diseases. Most of the therapies cost more than the patients' monthly income.
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Affiliation(s)
- Zornitsa Mitkova
- Faculty of Pharmacy, Medical University of Sofia, 1000 Sofia, Bulgaria; (I.M.); (K.T.); (M.D.); (G.P.)
| | - Ivan Manev
- Faculty of Pharmacy, Medical University of Sofia, 1000 Sofia, Bulgaria; (I.M.); (K.T.); (M.D.); (G.P.)
| | - Konstantin Tachkov
- Faculty of Pharmacy, Medical University of Sofia, 1000 Sofia, Bulgaria; (I.M.); (K.T.); (M.D.); (G.P.)
| | - Vladimira Boyadzhieva
- Rheumatology Clinic, University Hospital St. Ivan Rilski, Faculty of Medicine, Medical University of Sofia, 1612 Sofia, Bulgaria; (V.B.); (N.S.)
| | - Nikolay Stoilov
- Rheumatology Clinic, University Hospital St. Ivan Rilski, Faculty of Medicine, Medical University of Sofia, 1612 Sofia, Bulgaria; (V.B.); (N.S.)
| | - Miglena Doneva
- Faculty of Pharmacy, Medical University of Sofia, 1000 Sofia, Bulgaria; (I.M.); (K.T.); (M.D.); (G.P.)
| | - Guenka Petrova
- Faculty of Pharmacy, Medical University of Sofia, 1000 Sofia, Bulgaria; (I.M.); (K.T.); (M.D.); (G.P.)
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15
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Alowairdhi MA, Alhussain FH, Alomran MI, Almadani OA, Alkhammash NA, Alyabes SF, Alharbi SA, Almudaiheem EA, Alhaider RA, Alhassan SA, Almuallem ZA, Algain N, Alshehri AO, Alshammari TM, Althunian TA. The association between drug pricing and drug shortage in Saudi Arabia: a retrospective database analysis. J Pharm Policy Pract 2023; 16:91. [PMID: 37464406 DOI: 10.1186/s40545-023-00591-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/26/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Previous studies have suggested that drug pricing could contribute to drug shortages; however, there is limited quantitative assessment of this potential causal association. This retrospective database analysis aimed to investigate the association between drug prices and drug shortage incidents in Saudi Arabia. METHODS This was a retrospective database analysis study. Drugs with shortage notifications sent to the Saudi Food and Drug Authority (SFDA) between January 2017 and December 2020 were included. Each drug's foreign-to-Saudi price ratio (FTSPR) was calculated by dividing the mean international price by the Saudi price. Drugs were categorized into three groups based on their FTSPR: Group 1 (FTSPR > 1), Group 2 (FTSPR = 1), and Group 3 (FTSPR < 1). The primary outcome was the ratio of mean counts (mCR) between the three groups, with Group 3 serving as the control group. The analysis was adjusted for the measured confounders using a negative binomial regression model. RESULTS A total of 900 drugs were included in the study, with 348 in Group 1, 345 in Group 2, and 209 in Group 3. The mean count in Group 1 was higher compared to Group 3 (mCR: 1.88; 95% confidence interval [CI] 1.24 to 2.83), while the mean counts between Group 2 and Group 3 were comparable (mCR: 1.39; 95% CI 0.92 to 2.09). CONCLUSIONS Our findings indicate an association between drug shortage incidents and higher prices of drugs outside Saudi Arabia. Further studies are needed to explore this causal relationship in different contexts.
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Affiliation(s)
- Mohammad A Alowairdhi
- Department of Pricing and Pharmacoeconomics, Saudi Food and Drug Authority, Riyadh, Saudi Arabia
| | - Fatimah H Alhussain
- Department of Pricing and Pharmacoeconomics, Saudi Food and Drug Authority, Riyadh, Saudi Arabia
| | - Maha I Alomran
- Research Informatics Department, Saudi Food and Drug Authority, Riyadh, Saudi Arabia
| | - Ohoud A Almadani
- Research Informatics Department, Saudi Food and Drug Authority, Riyadh, Saudi Arabia
| | - Norah A Alkhammash
- Drug Availability and Tracking Center, Saudi Food and Drug Authority, Riyadh, Saudi Arabia
| | - Shayma F Alyabes
- Drug Availability and Tracking Center, Saudi Food and Drug Authority, Riyadh, Saudi Arabia
| | - Sultan A Alharbi
- Department of Pricing and Pharmacoeconomics, Saudi Food and Drug Authority, Riyadh, Saudi Arabia
| | - Esraa A Almudaiheem
- Department of Pricing and Pharmacoeconomics, Saudi Food and Drug Authority, Riyadh, Saudi Arabia
| | - Reem A Alhaider
- Department of Pricing and Pharmacoeconomics, Saudi Food and Drug Authority, Riyadh, Saudi Arabia
| | - Sara A Alhassan
- Department of Pricing and Pharmacoeconomics, Saudi Food and Drug Authority, Riyadh, Saudi Arabia
| | - Zainab A Almuallem
- Department of Pricing and Pharmacoeconomics, Saudi Food and Drug Authority, Riyadh, Saudi Arabia
| | - Nuha Algain
- Department of Pricing and Pharmacoeconomics, Saudi Food and Drug Authority, Riyadh, Saudi Arabia
| | - Abdulaziz O Alshehri
- Department of Pricing and Pharmacoeconomics, Saudi Food and Drug Authority, Riyadh, Saudi Arabia
| | | | - Turki A Althunian
- Research Informatics Department, Saudi Food and Drug Authority, Riyadh, Saudi Arabia.
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
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Machline-Carrion MJ, Girotto AN, Nieri J, Pereira PM, Monfardini F, Forestiero F, Raupp P, Roveda F, Santo K, Berwanger O, Santos RD. Assessing statins use in a real-world primary care digital strategy: a cross-sectional analysis of a population-wide digital health approach. LANCET REGIONAL HEALTH. AMERICAS 2023; 23:100534. [PMID: 37497398 PMCID: PMC10366451 DOI: 10.1016/j.lana.2023.100534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/19/2023] [Accepted: 06/01/2023] [Indexed: 07/28/2023]
Abstract
Background The digitization of the primary care system provides an opportunity to evaluate the current use of statins in secondary prevention populations (myocardial infarction or stroke). Methods We conducted a cross-sectional study (ClinicalTrials.gov, NCT05285085), analysing anonymised data routinely collected by community health workers (CHW) in Brazil between May 2016 and September 2021 to assess the proportion of self-reported statins use and associated factors. Findings From the 2,133,900 individuals on the database, 35,103 (1.6%), mean age 66.2 years (SD14.6), 49.5% (17,382/35,103) male sex, 50.5% (17,721/35,103) female sex, and 29.6% (10,381/34,975) Caucasians, had a previous myocardial infarction (MI) (n = 11,628; 33.1%) or stroke (n = 25,925; 73.9%). Approximately 50% (17,020/35,103) were from the Northeast region, 78.7% (27,605) from urban zones, and 39.4% (13,845) with social development index (SDI) >0.7. Overall, 6.7% (2346) and 0.6% (212) reported statins and high dose statins use, respectively. Age over 60 years old (OR 1.32 [95% CI 1.19-1.47), living in the Southern region (OR 4.53 [95% CI 3.66-5.60]), having a previous diagnosis of MI (OR 4.53 [95% CI 3.66-5.60]), heart failure (OR 2.29 [95% CI 1.13-1.47]), diabetes (OR 1.50 [95% CI 1.37-1.64]), dyslipidaemia (OR 2.90 [95% CI 2.55-3.29]), chronic kidney disease (OR 1.27 [95% CI 1.08-1.48]) and use of anti-hypertensives (OR 5.47 [95% CI 4.60-6.47]) were associated with statin use. Interpretation The analysis of a real-world database from a digitized primary care system, allowed us to identify a very low use of statins in secondary prevention Brazilian patients, mostly influenced by socio-demographic factors and co-morbidities. Funding Novartis Biociências, Brazil.
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Affiliation(s)
| | | | - Josué Nieri
- Academic Research Organization (ARO), Hospital Israelita Albert Einstein (HIAE), São Paulo, SP, Brazil
| | | | - Frederico Monfardini
- Academic Research Organization (ARO), Hospital Israelita Albert Einstein (HIAE), São Paulo, SP, Brazil
| | | | | | | | - Karla Santo
- Academic Research Organization (ARO), Hospital Israelita Albert Einstein (HIAE), São Paulo, SP, Brazil
| | - Otávio Berwanger
- Academic Research Organization (ARO), Hospital Israelita Albert Einstein (HIAE), São Paulo, SP, Brazil
- The George Institute for Global Health, London, United Kingdom
- Imperial College London, London, United Kingdom
| | - Raul D. Santos
- Academic Research Organization (ARO), Hospital Israelita Albert Einstein (HIAE), São Paulo, SP, Brazil
- Lipid Clinic Heart Institute InCor University of Sao Paulo Medical School Hospital, São Paulo, SP, Brazil
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Talha KM, Butler J, Greene SJ, Aggarwal R, Anker SD, Claggett BL, Docherty KF, Solomon SD, McMurray JJV, Januzzi JL, Vaduganathan M, Fonarow GC. Potential global impact of sodium-glucose cotransporter-2 inhibitors in heart failure. Eur J Heart Fail 2023; 25:999-1009. [PMID: 37062865 DOI: 10.1002/ejhf.2864] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/31/2023] [Accepted: 04/05/2023] [Indexed: 04/18/2023] Open
Abstract
AIMS Sodium-glucose cotransporter-2 (SGLT-2) inhibitors are effective across the spectrum of left ventricular ejection fraction (LVEF) in heart failure (HF); however, population-wide medication use in eligible patients remains suboptimal. We evaluated the potential implications of optimal global implementation of SGLT-2 inhibitors in HF. METHODS AND RESULTS A decision analytical study was performed using the global prevalence of HF from the Global Burden of Disease 2017 report. Exclusion criteria were applied using the NHANES to ascertain an SGLT-2 inhibitor-eligible population, which was mapped onto global LVEF distributions from the REPORT-HF registry. The number needed to treat for 3 years for the composite of worsening HF events and cardiovascular deaths was calculated from estimated event rates in the DAPA-HF, EMPEROR-Reduced, EMPEROR-Preserved, and DELIVER trials and projected onto the eligible population. An estimated 49 329 000 (95% confidence interval [CI] 43 882 000-54 929 000) HF patients would be eligible for SGLT-2 inhibitors across all LVEFs, including 25 651 000 (95% CI 22 818 000-28 563 000) with LVEF ≤40% and 23 678 000 (95% CI 21 063 000-26 366 000) with LVEF >40%. Optimal implementation of SGLT-2 inhibitors would be projected to prevent/postpone 4 512 011 (95% CI 4 013 686-5 024 232) to 5 986 943 (95% CI 5 325 721-6 666 604) total worsening HF events and cardiovascular deaths over 3 years in patients with LVEF <40%. An additional 2 102 606 (95% CI 1 870 394-2 341 301) to 2 557 224 (95% CI 2 274 804-2 847 528) total worsening HF events and cardiovascular deaths would be prevented/postponed in patients with LVEF >40%. Among all eligible HF patients, irrespective of LVEF, 7 069 235 (95% CI 6 288 490-7 871 760) to 8 089 549 (95% CI 7 196 115-9 007 905) total worsening HF events and cardiovascular deaths would be prevented/postponed over this period. CONCLUSIONS Optimal implementation of SGLT-2 inhibitors globally in HF is projected to prevent/postpone approximately 7-8 million worsening HF events and cardiovascular deaths over 3 years.
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Affiliation(s)
- Khawaja M Talha
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
| | | | - Rahul Aggarwal
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Stefan D Anker
- Department of Cardiology (CVK) of German Heart Center Charité; Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin, Berlin, Germany
| | - Brian L Claggett
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kieran F Docherty
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - James L Januzzi
- Massachusetts General Hospital, Harvard Medical School, and Baim Institute for Clinical Research, Boston, MA, USA
| | - Muthiah Vaduganathan
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Gregg C Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, University of California Los Angeles, Los Angeles, CA, USA
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Ooms GI, van Oirschot J, de Kant D, van den Ham HA, Mantel-Teeuwisse AK, Reed T. Barriers to accessing internationally controlled essential medicines in sub-saharan Africa: A scoping review. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 118:104078. [PMID: 37276779 DOI: 10.1016/j.drugpo.2023.104078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 05/14/2023] [Accepted: 05/22/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Access to internationally controlled essential medicines (ICEMs), medicines that are listed on both the World Health Organization's Essential Medicines List and one of three international drug control conventions, remains problematic in Sub-Saharan Africa (SSA). Previous reviews have focused only on specific ICEMs or ICEM-related healthcare fields, but none have focused on all ICEMs as a distinct class. This scoping review therefore aims to identify the barriers to accessing ICEMs across all relevant healthcare fields in SSA. METHODS A scoping review was conducted across indexing platforms Embase, PubMed, Scopus and Web of Science of studies published between January 1 2012 and February 1 2022. Articles were eligible if they mentioned barriers to accessing ICEMs and/or ICEM-related healthcare fields, if studies were conducted in SSA, or included data on an SSA country within a multi-country study. The review was guided by the Access to Medicines from a Health System Perspective framework. RESULTS The search identified 5519 articles, of which 97 met the inclusion criteria. Many barriers to access were reported and were common across the ICEMs drug class. Main barriers were: at the individual level, the lack of knowledge about ICEMs; at the health service delivery level, low availability, stockouts, affordability, long distances to health facilities, insufficient infrastructure to store and distribute ICEMs, and lack of ICEM knowledge and training among healthcare workers; at the health sector level, lack of prioritisation of ICEM-related healthcare fields by governments and subsequent insufficient budget allocation. Cross-cutting, governance-related barriers pertained to lack of proper quantification systems, cumbersome procurement processes, and strict national laws controlling ICEMs, leading to overly restrictive prescription practices. CONCLUSION This review showed that there are a multitude of barriers to accessing ICEMs in SSA across all health system levels. Many of the barriers identified are applicable to all ICEMs, highlighting the importance of tackling barriers for this entire class of drugs together.
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Affiliation(s)
- Gaby I Ooms
- Utrecht WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands; Health Action International, Amsterdam, the Netherlands.
| | | | | | - Hendrika A van den Ham
- Utrecht WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands
| | - Aukje K Mantel-Teeuwisse
- Utrecht WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands
| | - Tim Reed
- Health Action International, Amsterdam, the Netherlands
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Harrison MA, Marfo AFA, Annan A, Ankrah DNA. Access to cardiovascular medicines in low- and middle-income countries: a mini review. Glob Health Res Policy 2023; 8:17. [PMID: 37221559 DOI: 10.1186/s41256-023-00301-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 05/07/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Many cardiovascular (CV) medicines are required for long term. However, with their limited resources, low- and middle-income countries (LMICs) may have challenges with access to cardiovascular medicines. The aim of this review was to provide a summary of available evidence on access to cardiovascular medicines in LMICs. METHODS We searched PubMed and Google scholar for English language articles on access to cardiovascular medicines for the period 2010-2022. We also searched for articles reporting measures for challenges in access to CV medicines from 2007 to 2022. Studies conducted in LMICs, and reporting availability and affordability were included for review. We also reviewed studies reporting affordability or availability using the World Health Organisation/Health Action International (WHO/HAI) method. Levels of affordability and availability were compared. RESULTS Eleven articles met the inclusion criteria for review on availability and affordability. Although availability appears to have improved, many countries did not meet the availability target of 80%. Between economies and within countries, there are equity gaps in access to CV medicines. Availability is lower in public health facilities than private facilities. Seven out of 11 studies reported availability less than 80%. Eight studies which investigated availability in the public sector reported less than 80% availability. Overall, CV medicines, especially combined treatments are not affordable in the majority of countries. Simultaneous achievement of availability and affordability target is low. In the studies reviewed, less than 1-53.5 days wages were required to purchase one month supply of CV medicines. Failure to meet affordability was 9-75%. Five studies showed that, on average 1.6 days' wages of the Lowest-Paid Government Worker (LPGW) was required to purchase generic CV medicines in the public sector. Efficient forecasting and procurement, increased public financing and policies to improve generic use, among others are measures for improving availability and affordability. CONCLUSIONS Significant gaps exist in access to cardiovascular medicines in LMICs, and in many low-and lower middle-income countries access to cardiovascular medicines is low. To improve access and achieve the Global Action Plan on non-communicable diseases in these countries, policy interventions must be urgently instituted.
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Affiliation(s)
- Mark Amankwa Harrison
- Pharmacy Department, Korle Bu Teaching Hospital, Korle Bu, P.O. Box 77, Accra, Ghana.
- Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Afia Frimpomaa Asare Marfo
- Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Augustine Annan
- Pharmacy Department, Korle Bu Teaching Hospital, Korle Bu, P.O. Box 77, Accra, Ghana
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Fiorini G, Franchi M, Pellegrini G, Rigamonti AE, Sartorio A, Marazzi N, Corrao G, Cella SG. Characterizing non-communicable disease trends in undocumented migrants over a period of 10 years in Italy. Sci Rep 2023; 13:7424. [PMID: 37156791 PMCID: PMC10167203 DOI: 10.1038/s41598-023-34572-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 05/03/2023] [Indexed: 05/10/2023] Open
Abstract
Undocumented migrants represent a large part of the population in Countries of the European Union (EU) such as Italy. Their health burden is not fully understood and likely to be related mainly to chronic conditions. Information on their health needs and conditions may help to target public health interventions but is not found in national public health databases. We conducted a retrospective observational study of non-communicable disease (NCD) burden and management in undocumented migrants receiving medical care from Opera San Francesco, a non-governmental organization (NGO) in Milan, Italy. We analyzed the health records of 53,683 clients over a period of 10 years and collected data on demographics, diagnosis and pharmacological treatments prescribed. 17,292 (32.2%) of clients had one or more NCD diagnosis. The proportion of clients suffering from at least one NCD increased from 2011 to 2020. The risk of having an NCD was lower in men than women (RR = 0.88, 95% CI 0.86-0.89), increased with age (p for trend < 0.001) and changed with ethnicity. African and Asian migrants had a lower risk than Europeans of cardiovascular diseases (RR 0.62 CI 0.58-0.67, RR 0.85 CI 0.78-0.92 respectively) and mental health disorders (RR 0.66 CI 0.61-0.71, RR 0.60 CI 0.54-0.67 respectively), while the risk was higher in Latin American people (RR 1.07 CI 1.01-1.13, RR 1.18 CI 1.11-1.25). There was a higher risk of diabetes in those from Asia and Latin America (RR 1.68 CI 1.44-1.97, RR 1.39 CI 1.21-1.60). Overall, migrants from Latin America had the greatest risk of chronic disease and this was true for diabetes, cardiovascular diseases and mental health disorders. Undocumented migrants demonstrate a significantly different health burden of NCDs, which varies with ethnicity and background. Data from NGOs providing them with medical assistance should be included in structuring public health interventions aimed at the prevention and treatment of NCDs. This could help to better allocate resources and address their health needs.
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Affiliation(s)
- Gianfrancesco Fiorini
- Istituti Clinici Zucchi, GSD, Monza, Italy
- Laboratory of Clinical Pharmacology and Pharmacoepidemiology, Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy
| | - Matteo Franchi
- National Centre for Healthcare Research and Pharmacoepidemiology, Milan, Italy
- Laboratory of Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano Bicocca, Milan, Italy
| | - Giacomo Pellegrini
- National Centre for Healthcare Research and Pharmacoepidemiology, Milan, Italy
| | - Antonello Emilio Rigamonti
- Laboratory of Clinical Pharmacology and Pharmacoepidemiology, Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy
| | - Alessandro Sartorio
- Experimental Laboratory for Auxo-Endocrinological Research, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Nicoletta Marazzi
- Experimental Laboratory for Auxo-Endocrinological Research, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Giovanni Corrao
- National Centre for Healthcare Research and Pharmacoepidemiology, Milan, Italy
- Laboratory of Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano Bicocca, Milan, Italy
| | - Silvano Gabriele Cella
- National Centre for Healthcare Research and Pharmacoepidemiology, Milan, Italy.
- Laboratory of Clinical Pharmacology and Pharmacoepidemiology, Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy.
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Kazi SN, Von Huben A, Marschner S, Chong JJH, Denniss AR, Ong ATL, Chow CK. Trends in Modifiable Risk Factors Amongst First Presentation ST Elevation Myocardial Infarction Patients in a Large Longitudinal Registry. Heart Lung Circ 2023; 32:480-486. [PMID: 36801127 DOI: 10.1016/j.hlc.2022.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 08/18/2022] [Accepted: 12/20/2022] [Indexed: 02/18/2023]
Abstract
BACKGROUND Recent studies suggest that the risk factor profile of patients presenting with ST elevation myocardial infarction (STEMI) is changing. AIM The aim is to determine if there has been a shift of cardiovascular risk factors to cardiometabolic causes in the first presentation STEMI population. METHOD We analysed data from a STEMI registry from a large tertiary referral percutaneous coronary intervention centre to determine the prevalence and trends of the modifiable risk factors of hypertension, diabetes, smoking and hypercholesterolaemia. PARTICIPANTS Consecutive first presentation STEMI patients between January 2006 to December 2018. RESULTS Among the 2,366 patients included (mean age 59, SD 12.66, 80% male) the common risk factors were hypertension (47%), hypercholesterolaemia (47%) current smoking (42%) and diabetes (27%). Over the 13 years, patients with diabetes (20% to 26%, OR 1.09 per year, CI 1.06-1.11, p<0.001) and patients with no modifiable risk factors increased (9% to 17%, OR 1.08, CI 1.04-1.11, p<0.001). Concurrently there was a fall in prevalence of hypercholesterolaemia, (47% to 37%, OR 0.94 per year, CI 0.92-0.96, p<0.001) and smoking (44% to 41%, OR 0.94, CI 0.92-0.96, p<0.001) but no significant change in rates of hypertension (53% to 49%, OR 0.99, CI 0.97-1.01, p=0.25). CONCLUSION The risk factor profile of first presentation STEMI has changed over time with a reduction in smoking and a concurrent rise in patients with no traditional risk factors. This suggests the mechanism of STEMI may be changing and further investigation of potential causal factors is warranted for the prevention and management of cardiovascular disease.
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Affiliation(s)
- Samia N Kazi
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; Westmead Applied Research Centre and Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Amy Von Huben
- Westmead Applied Research Centre and Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Simone Marschner
- Westmead Applied Research Centre and Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - James J H Chong
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; Centre for Heart Research, The Westmead Institute for Medical Research, Sydney, NSW, Australia
| | - Alan Robert Denniss
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; Department of Cardiology, Blacktown Hospital, Sydney, NSW, Australia; School of Medicine, Western Sydney University, Sydney, NSW, Australia
| | - Andrew T L Ong
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
| | - Clara K Chow
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; Westmead Applied Research Centre and Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
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22
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Alabdaljabar MS, Hasan B, Noseworthy PA, Maalouf JF, Ammash NM, Hashmi SK. Machine Learning in Cardiology: A Potential Real-World Solution in Low- and Middle-Income Countries. J Multidiscip Healthc 2023; 16:285-295. [PMID: 36741292 PMCID: PMC9891080 DOI: 10.2147/jmdh.s383810] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 11/07/2022] [Indexed: 01/30/2023] Open
Abstract
Artificial intelligence (AI) and machine learning (ML) is a promising field of cardiovascular medicine. Many AI tools have been shown to be efficacious with a high level of accuracy. Yet, their use in real life is not well established. In the era of health technology and data science, it is crucial to consider how these tools could improve healthcare delivery. This is particularly important in countries with limited resources, such as low- and middle-income countries (LMICs). LMICs have many barriers in the care continuum of cardiovascular diseases (CVD), and big portion of these barriers come from scarcity of resources, mainly financial and human power constraints. AI/ML could potentially improve healthcare delivery if appropriately applied in these countries. Expectedly, the current literature lacks original articles about AI/ML originating from these countries. It is important to start early with a stepwise approach to understand the obstacles these countries face in order to develop AI/ML-based solutions. This could be detrimental to many patients' lives, in addition to other expected advantages in other sectors, including the economy sector. In this report, we aim to review what is known about AI/ML in cardiovascular medicine, and to discuss how it could benefit LMICs.
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Affiliation(s)
- Mohamad S Alabdaljabar
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Babar Hasan
- Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan
| | | | - Joseph F Maalouf
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA,Department of Medicine, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Naser M Ammash
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA,Department of Medicine, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Shahrukh K Hashmi
- Department of Medicine, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates,Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA,Correspondence: Shahrukh K Hashmi, Department of Medicine, SSMC, Abu Dhabi, United Arab Emirates, Email
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Wata D, Ogwu J, Dunford L, Lawson G, Tanna S. Utilizing quantitative dried blood spot analysis to objectively assess adherence to cardiovascular pharmacotherapy among patients at Kenyatta National Hospital, Nairobi, Kenya. PLoS One 2023; 18:e0280137. [PMID: 36662714 PMCID: PMC9858374 DOI: 10.1371/journal.pone.0280137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 12/20/2022] [Indexed: 01/21/2023] Open
Abstract
The burden of cardiovascular disease (CVD) is rising in Kenya and non-adherence to cardiovascular pharmacotherapy is a growing global public health issue that leads to treatment failure, an increased risk of cardiac events and poor clinical outcomes. This study assessed adherence to selected cardiovascular therapy medications among CVD patients attending outpatient clinics at Kenyatta National Hospital, Kenya by determining drug concentration(s) in patient dried blood spot (DBS) samples. Patients who had been taking one or more of the five commonly prescribed CVD medications (amlodipine, atenolol, atorvastatin, losartan, and valsartan) for at least six months were enrolled. Each patient completed a short questionnaire about their medication history and then provided a finger-prick blood spot sample from which drug concentrations were determined by liquid chromatography-high resolution mass spectrometry analysis. Two hundred and thirty-nine patients (62.3% female) participated in the study. The median number of medications used by patients was 2 (IQR 75%-25% is 3-1). Less than half (117; 49.0%) of patients were adherent to their prescribed CVD pharmacotherapy. Binary regression analysis revealed a significant correlation between non-adherence and the number of medications in the treatment regimen (Odds Ratio (OR) 1.583; 95%CI: 0.949-2.639; P-value = 0.039) and that gender was not an independent predictor of medication adherence (OR 1.233; 95%CI: 0.730-2.083; P-value = 0.216). Valuable information about adherence to each medication in the patient's treatment regimen was obtained using quantitative DBS analysis showing that adherence to CVD medications was not uniform. DBS sampling, due its minimally invasive nature, convenience and ease of transport is a useful alternative matrix to monitor adherence to pharmacotherapies objectively, when combined with hyphenated mass spectrometry analytical techniques. This information can provide physicians with an evidence-based novel approach towards personalization and optimization of CVD pharmacotherapy and implementing interventions in the Kenyan population, thereby improving clinical outcomes.
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Affiliation(s)
- David Wata
- Department of Pharmacy, Kenyatta National Hospital, Nairobi, Kenya
| | - John Ogwu
- Faculty of Health and Life Sciences, Leicester School of Pharmacy, De Montfort University, Leicester, United Kingdom
| | - Louise Dunford
- Faculty of Health and Life Sciences, Leicester School of Allied Health, De Montfort University, Leicester, United Kingdom
| | - Graham Lawson
- Faculty of Health and Life Sciences, Leicester School of Pharmacy, De Montfort University, Leicester, United Kingdom
| | - Sangeeta Tanna
- Faculty of Health and Life Sciences, Leicester School of Pharmacy, De Montfort University, Leicester, United Kingdom
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Kanesamoorthy S, Sheron VA, Uruthirakumar P, Kodippily C, Kumarendran B, Gooden TE, Thomas GN, Nirantharakumar K, Lip GYH, Guruparan M, Haniffa R, Surenthirakumaran R, Beane A, Subaschandran K. Prevalence of atrial fibrillation in Northern Sri Lanka: a study protocol for a cross-sectional household survey. BMJ Open 2022; 12:e056480. [PMID: 36418134 PMCID: PMC9685242 DOI: 10.1136/bmjopen-2021-056480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Atrial fibrillation (AF) is the most common arrhythmia globally. It is associated with a fivefold risk in stroke, but early diagnosis and effective treatment can reduce this risk. AF is often underdiagnosed, particularly in low-income and middle-income countries (LMICs) where screening for AF is not always feasible or considered common practice in primary care settings. Epidemiological data on AF in LMICs is often incomplete particularly in vulnerable populations. This LMIC research collaborative aims to identify the prevalence of AF in the Northern Sri Lankan community. METHODS AND ANALYSIS A cross-sectional household survey piloted and codesigned through a series of community engagement events will be administered in all five districts in Northern Province, Sri Lanka. A multistage cluster sampling approach will be used starting at district level, then the Divisional Secretariats followed by Grama Niladhari divisions. Twenty households will be selected from each cluster. The study aims to recruit 10 000 participants aged 50 years or older, 1 participant per household. Demographic and socioeconomic characteristics, well-being and lifestyle and anthropometric measurements will be collected using a digital data platform (REDCap, Research Electronic Data Capture) by trained data collectors. Participants will be screened for AF using a fingertip single-lead ECG via a smartphone application (AliveCor) with rhythm strips reviewed by a consultant cardiologist. Prevalence of AF and risk factors will be established at province and district-levels. Adjusted ORs and population attributable fractions for AF risk factors will be determined. ETHICS AND DISSEMINATION This study was approved by the Ethics Review Committee of Faculty of Medicine at University of Jaffna. Written informed consent will be obtained from all participants. Findings will be disseminated through publication in a peer-reviewed journal and presentations at conferences. The findings will enable early treatment for new AF diagnoses and inform interventions to improve community-based management of AF in LMICs.
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Affiliation(s)
- Shribavan Kanesamoorthy
- Department of Community and Family Medicine, University of Jaffna, Jaffna, Northern Province, Sri Lanka
| | | | - Powsiga Uruthirakumar
- Department of Community and Family Medicine, University of Jaffna, Jaffna, Northern Province, Sri Lanka
| | - Chamira Kodippily
- National Intensive Care Surveillance-Mahidol Oxford Tropical Medicine Research Unit, Jaffna, Sri Lanka
| | - Balachandran Kumarendran
- Department of Community and Family Medicine, University of Jaffna, Jaffna, Northern Province, Sri Lanka
| | - Tiffany E Gooden
- Department of Public Health and Epidemiology, University of Birmingham, Birmingham, UK
| | - Graham Neil Thomas
- Department of Public Health and Epidemiology, University of Birmingham, Birmingham, UK
| | | | - Gregory Y H Lip
- Department of Public Health and Epidemiology, University of Birmingham, Birmingham, UK
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, Merseyside, UK
| | - Mahesan Guruparan
- Department of Cardiology, Jaffna Teaching Hospital, Jaffna, Sri Lanka
| | - Rashan Haniffa
- Centre for Inflammation Research, The University of Edinburgh, Edinburgh, UK
| | | | - Abi Beane
- Centre for Inflammation Research, The University of Edinburgh, Edinburgh, UK
| | - Kumaran Subaschandran
- Department of Community and Family Medicine, University of Jaffna, Jaffna, Northern Province, Sri Lanka
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Lamy A, Tong W, Joseph P, Gao P, Pais P, Lopez-Jaramillo P, Walli-Attaei M, Dans AL, Xavier D, Talukder S, Santoso A, Gamra H, Yusuf S. The cost implications of a polypill for primary prevention in the TIPS-3 trial. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2022; 8:899-908. [PMID: 34962984 DOI: 10.1093/ehjqcco/qcab101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/02/2021] [Accepted: 12/23/2021] [Indexed: 12/29/2022]
Abstract
AIMS The International Polycap Study 3 (TIPS-3) trial demonstrated that a polypill containing cholesterol- and multiple blood-pressure-lowering drugs reduces cardiovascular events by 20% compared with placebo in people without cardiovascular disease. The polypill plus aspirin led to a 31% relative risk reduction in cardiovascular disease events compared with double placebo. We report regional variations in costs and affordability of a polypill based on the TIPS-3 trial. METHODS AND RESULTS Countries were categorized using World Bank economic groups: lower-middle-income, upper-middle-income, and high-income countries. Country-specific costs were obtained for hospitalization events, procedures, and non-study medications (2019 US dollars). Polypill price was based on the cheapest equivalent substitute (CES) for each component. For the polypill vs. placebo, the difference in cost over the 4.6 years of the trial was $291 [95% confidence interval (CI): $243-339] per participant in lower-middle-income countries, $1068 (95% CI: $992-1144) in upper-middle-income countries, and $48 (95% CI: -$271 to $367) in high-income countries. Results were similar for the polypill plus aspirin vs. a double placebo. In both cases, the polypill was affordable in all groups using monthly household capacity to pay or a threshold of 4% of the gross national income per capita. CONCLUSION The use of a polypill (CES) in TIPS-3 increases costs in lower-middle-income countries and upper-middle-income countries but is affordable in countries at various economic levels and is cost neutral (dominant) in high-income countries.
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Affiliation(s)
- Andre Lamy
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, DBCVSRI, 20 Copeland Avenue, Hamilton, ON L8L 2X2, Canada
| | - Wesley Tong
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, DBCVSRI, 20 Copeland Avenue, Hamilton, ON L8L 2X2, Canada
| | - Philip Joseph
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, DBCVSRI, 20 Copeland Avenue, Hamilton, ON L8L 2X2, Canada
| | - Peggy Gao
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, DBCVSRI, 20 Copeland Avenue, Hamilton, ON L8L 2X2, Canada
| | - Prem Pais
- St. John's Medical College, Division of Clinical Research and Training, Bangalore, India
| | | | - Marjan Walli-Attaei
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, DBCVSRI, 20 Copeland Avenue, Hamilton, ON L8L 2X2, Canada
| | - Antonio L Dans
- Department of Medicine, UP College of Medicine, University of the Philippines Manila, Padre Faura Street, Ermita, Manila, Metro Manila, Phillipines
| | - Denis Xavier
- St. John's Medical College, Division of Clinical Research and Training, Bangalore, India
| | | | - Anwar Santoso
- Department of Cardiology and Vascular Medicine, Universitas Indonesia, National Cardiovascular Center, Jakarta, Indonesia
| | - Habib Gamra
- Fattouma Bourguiba Hospital and University of Monastir, Monastir, Tunisia
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, DBCVSRI, 20 Copeland Avenue, Hamilton, ON L8L 2X2, Canada
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Gupta R, Makkar JS, Sharma SK, Agarwal A, Sharma KK, Bana A, Kasliwal A, Sidana SK, Degawat PR, Bhagat KK, Natani V, Khedar RS, Sharma SK. Association of health insurance status with coronary risk factors, coronary artery disease, interventions and outcomes in India. INTERNATIONAL JOURNAL OF CARDIOLOGY CARDIOVASCULAR RISK AND PREVENTION 2022; 14:200146. [PMID: 36060285 PMCID: PMC9434410 DOI: 10.1016/j.ijcrp.2022.200146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 07/14/2022] [Accepted: 07/23/2022] [Indexed: 11/30/2022]
Abstract
Objective Coronary artery disease (CAD) related hospitalization and interventions are associated with catastrophic out-of-pocket health expenditure in India. To evaluate differences in risk factors, disease severity, management and outcomes in uninsured vs insured CAD patients we performed a study. Methods Successive CAD patients who underwent percutaneous intervention (PCI) at our centre were enrolled from January 2018 to June 2021. Clinical, angiographic and intervention data were periodically uploaded in the American College of Cardiology CathPCI platform. Descriptive statistics are reported. Results 4672 CAD patients (men 3736, women 936) were included; uninsured were 2166 (46%), government insurance was in 1635 (36%) and private insurance in 871 (18%). Mean age was 60.1 ± 11 years, uninsured <50y were 21.6% vs 14.0% and 20.3% with government and private insurance. Among the uninsured prevalence of raised total and non-HDL cholesterol, any tobacco use, ST-elevation myocardial infarction (STEMI) and ejection fraction <30% were more (p < 0.01). In the STEMI group (n = 1985), rates of primary PCI were the highest in those with private insurance (38.7%) compared to others. Multivessel stenting (≥2 stents) was more among the insured patients. Median length of hospital stay was similar in the three groups. In-hospital mortality was slightly more in the uninsured (1.43%), compared to government (0.88) and privately insured (0.82) (p = 0.242). The cost of hospitalization and procedures was the highest among uninsured (US$ 2240, IQR 1877–2783) compared to government (US$ 1977, IQR 1653–2437) and privately insured (US$ 2013, IQR 1668–2633) (p < 0.001). Conclusions Uninsured CAD patients in India are younger with more risk factors, acute coronary syndrome, STEMI, multivessel disease and coronary stenting compared to those with government or private insurance. The uninsured bear significantly greater direct costs with slightly greater mortality.
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Agarwal A, Husain MJ, Datta B, Kishore SP, Huffman MD. Access to Heart Failure Medicines in Low- and Middle-Income Countries: An Analysis of Essential Medicines Lists, Availability, Price, and Affordability. Circ Heart Fail 2022; 15:e008971. [PMID: 35249355 PMCID: PMC9872096 DOI: 10.1161/circheartfailure.121.008971] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Anubha Agarwal
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Muhammad Jami Husain
- Global Noncommunicable Diseases Branch, Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, GA
| | - Biplab Datta
- Department of Population Health Sciences, Medical College of Georgia, Augusta University
| | | | - Mark D. Huffman
- Department of Medicine, Washington University in St. Louis, MO,The George Institute for Global Health, University of New South Wales, Sydney, Australia
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Yan LD, Lookens Pierre J, Rouzier V, Théard M, Apollon A, St Preux S, Kingery JR, Jamerson KA, Deschamps M, Pape JW, Safford MM, McNairy ML. Comparing six cardiovascular risk prediction models in Haiti: implications for identifying high-risk individuals for primary prevention. BMC Public Health 2022; 22:549. [PMID: 35305599 PMCID: PMC8933947 DOI: 10.1186/s12889-022-12963-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 03/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiovascular diseases (CVD) are rapidly increasing in low-middle income countries (LMICs). Accurate risk assessment is essential to reduce premature CVD by targeting primary prevention and risk factor treatment among high-risk groups. Available CVD risk prediction models are built on predominantly Caucasian risk profiles from high-income country populations, and have not been evaluated in LMIC populations. We aimed to compare six existing models for predicted 10-year risk of CVD and identify high-risk groups for targeted prevention and treatment in Haiti. METHODS We used cross-sectional data within the Haiti CVD Cohort Study, including 1345 adults ≥ 40 years without known history of CVD and with complete data. Six CVD risk prediction models were compared: pooled cohort equations (PCE), adjusted PCE with updated cohorts, Framingham CVD Lipids, Framingham CVD Body Mass Index (BMI), WHO Lipids, and WHO BMI. Risk factors were measured during clinical exams. Primary outcome was continuous and categorical predicted 10-year CVD risk. Secondary outcome was statin eligibility. RESULTS Sixty percent were female, 66.8% lived on a daily income of ≤ 1 USD, 52.9% had hypertension, 14.9% had hypercholesterolemia, 7.8% had diabetes mellitus, 4.0% were current smokers, and 2.5% had HIV. Predicted 10-year CVD risk ranged from 3.6% in adjusted PCE (IQR 1.7-8.2) to 9.6% in Framingham-BMI (IQR 4.9-18.0), and Spearman rank correlation coefficients ranged from 0.86 to 0.98. The percent of the cohort categorized as high risk using model specific thresholds ranged from 1.8% using the WHO-BMI model to 41.4% in the PCE model (χ2 = 1416, p value < 0.001). Statin eligibility also varied widely. CONCLUSIONS In the Haiti CVD Cohort, there was substantial variation in the proportion identified as high-risk and statin eligible using existing models, leading to very different treatment recommendations and public health implications depending on which prediction model is chosen. There is a need to design and validate CVD risk prediction tools for low-middle income countries that include locally relevant risk factors. TRIAL REGISTRATION clinicaltrials.gov NCT03892265 .
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Affiliation(s)
- Lily D Yan
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
- Center for Global Health, Weill Cornell Medicine, New York, NY, USA.
| | - Jean Lookens Pierre
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Vanessa Rouzier
- Center for Global Health, Weill Cornell Medicine, New York, NY, USA
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Michel Théard
- Collège Haïtien de Cardiologie, Port-au-Prince, Haiti
| | - Alexandra Apollon
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Stephano St Preux
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Justin R Kingery
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
- Center for Global Health, Weill Cornell Medicine, New York, NY, USA
| | - Kenneth A Jamerson
- Division of Cardiovascular Disease, Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Marie Deschamps
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Jean W Pape
- Center for Global Health, Weill Cornell Medicine, New York, NY, USA
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Monika M Safford
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Margaret L McNairy
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
- Center for Global Health, Weill Cornell Medicine, New York, NY, USA
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Marcus ME, Manne-Goehler J, Theilmann M, Farzadfar F, Moghaddam SS, Keykhaei M, Hajebi A, Tschida S, Lemp JM, Aryal KK, Dunn M, Houehanou C, Bahendeka S, Rohloff P, Atun R, Bärnighausen TW, Geldsetzer P, Ramirez-Zea M, Chopra V, Heisler M, Davies JI, Huffman MD, Vollmer S, Flood D. 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. Lancet Glob Health 2022; 10:e369-e379. [PMID: 35180420 PMCID: PMC8896912 DOI: 10.1016/s2214-109x(21)00551-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/05/2021] [Accepted: 11/16/2021] [Indexed: 02/09/2023]
Abstract
BACKGROUND In the prevention of cardiovascular disease, a WHO target is that at least 50% of eligible people use statins. Robust evidence is needed to monitor progress towards this target in low-income and middle-income countries (LMICs), where most cardiovascular disease deaths occur. The objectives of this study were to benchmark statin use in LMICs and to investigate country-level and individual-level characteristics associated with statin use. METHODS We did a cross-sectional analysis of pooled, individual-level data from nationally representative health surveys done in 41 LMICs between 2013 and 2019. Our sample consisted of non-pregnant adults aged 40-69 years. We prioritised WHO Stepwise Approach to Surveillance (STEPS) surveys because these are WHO's recommended method for population monitoring of non-communicable disease targets. For countries in which no STEPS survey was available, a systematic search was done to identify other surveys. We included surveys that were done in an LMIC as classified by the World Bank in the survey year; were done in 2013 or later; were nationally representative; had individual-level data available; and asked questions on statin use and previous history of cardiovascular disease. Primary outcomes were the proportion of eligible individuals self-reporting use of statins for the primary and secondary prevention of cardiovascular disease. Eligibility for statin therapy for primary prevention was defined among individuals with a history of diagnosed diabetes or a 10-year cardiovascular disease risk of at least 20%. Eligibility for statin therapy for secondary prevention was defined among individuals with a history of self-reported cardiovascular disease. At the country level, we estimated statin use by per-capita health spending, per-capita income, burden of cardiovascular diseases, and commitment to non-communicable disease policy. At the individual level, we used modified Poisson regression models to assess statin use alongside individual-level characteristics of age, sex, education, and rural versus urban residence. Countries were weighted in proportion to their population size in pooled analyses. FINDINGS The final pooled sample included 116 449 non-pregnant individuals. 9229 individuals reported a previous history of cardiovascular disease (7·9% [95% CI 7·4-8·3] of the population-weighted sample). Among those without a previous history of cardiovascular disease, 8453 were eligible for a statin for primary prevention of cardiovascular disease (9·7% [95% CI 9·3-10·1] of the population-weighted sample). For primary prevention of cardiovascular disease, statin use was 8·0% (95% CI 6·9-9·3) and for secondary prevention statin use was 21·9% (20·0-24·0). The WHO target that at least 50% of eligible individuals receive statin therapy to prevent cardiovascular disease was achieved by no region or income group. Statin use was less common in countries with lower health spending. At the individual level, there was generally higher statin use among women (primary prevention only, risk ratio [RR] 1·83 [95% CI 1·22-2·76), and individuals who were older (primary prevention, 60-69 years, RR 1·86 [1·04-3·33]; secondary prevention, 50-59 years RR 1·71 [1·35-2·18]; and 60-69 years RR 2·09 [1·65-2·65]), more educated (primary prevention, RR 1·61 [1·09-2·37]; secondary prevention, RR 1·28 [0·97-1·69]), and lived in urban areas (secondary prevention only, RR 0·82 [0·66-1·00]). INTERPRETATION In a diverse sample of LMICs, statins are used by about one in ten eligible people for the primary prevention of cardiovascular diseases and one in five eligible people for secondary prevention. There is an urgent need to scale up statin use in LMICs to achieve WHO targets. Policies and programmes that facilitate implementation of statins into primary health systems in these settings should be investigated for the future. FUNDING National Clinician Scholars Program at the University of Michigan Institute for Healthcare Policy and Innovation, and National Institute of Diabetes and Digestive and Kidney Diseases. TRANSLATION For the Spanish translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Maja E Marcus
- Department of Economics and Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany
| | - Jennifer Manne-Goehler
- Division of Infectious Diseases, Harvard Medical School, Boston, MA, USA; Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Michaela Theilmann
- Heidelberg Institute of Global Health, Heidelberg University and University Hospital, Heidelberg, Germany
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Saeedi Moghaddam
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Keykhaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirali Hajebi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Scott Tschida
- Center for Indigenous Health Research, Wuqu' Kawoq, Tecpán, Guatemala
| | - Julia M Lemp
- Heidelberg Institute of Global Health, Heidelberg University and University Hospital, Heidelberg, Germany
| | - Krishna K Aryal
- Public Health Promotion and Development Organization, Kathmandu, Nepal
| | - Matthew Dunn
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Corine Houehanou
- Laboratory of Epidemiology of Chronic and Neurological Diseases, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - Silver Bahendeka
- Department of Internal Medicine, MKPGMS Uganda Martyrs University, Kampala, Uganda; Saint Francis Hospital Nsambya, Kampala, Uganda
| | - Peter Rohloff
- Division of Global Health Equity, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Center for Indigenous Health Research, Wuqu' Kawoq, Tecpán, Guatemala
| | - Rifat Atun
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Department of Global Health and Population, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Till W Bärnighausen
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA; Heidelberg Institute of Global Health, Heidelberg University and University Hospital, Heidelberg, Germany; Africa Health Research Institute, Somkhele, South Africa
| | - Pascal Geldsetzer
- Heidelberg Institute of Global Health, Heidelberg University and University Hospital, Heidelberg, Germany; Division of Primary Care and Population Health, Stanford University, Stanford, CA, USA
| | - Manuel Ramirez-Zea
- INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - Vineet Chopra
- Division of Hospital Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI, USA; Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Michele Heisler
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA; Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Justine I Davies
- Institute for Applied Health Research, University of Birmingham, Birmingham, UK; Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa; Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Mark D Huffman
- Department of Medicine and Global Health Center, Washington University in St Louis, St Louis, MO, USA; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Sebastian Vollmer
- Department of Economics and Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany.
| | - David Flood
- Center for Indigenous Health Research, Wuqu' Kawoq, Tecpán, Guatemala; Division of Hospital Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI, USA; INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala.
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OUP accepted manuscript. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2022. [DOI: 10.1093/jphsr/rmac016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Ulloque-Badaracco JR, Mosquera-Rojas MD, Hernandez-Bustamante EA, Alarcón-Braga EA, Ulloque-Badaracco RR, Al-kassab-Córdova A, Herrera-Añazco P, Benites-Zapata VA, Hernandez AV. Association between Lipid Profile and Apolipoproteins with Risk of Diabetic Foot Ulcer: A Systematic Review and Meta-Analysis. Int J Clin Pract 2022; 2022:5450173. [PMID: 36016824 PMCID: PMC9385316 DOI: 10.1155/2022/5450173] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 06/21/2022] [Accepted: 07/19/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND AIMS Biomarkers are necessary to stratify the risk of diabetic foot ulcers (DFUs). This systematic review and meta-analysis aimed to evaluate the association between the lipid profile and apolipoproteins with the risk of DFU. METHODS A systematic search was conducted in PubMed, Scopus, Cochrane Library, and Web of Science among adult patients. Cohort and case-control studies were included. Random-effects models were used for meta-analyses, and the effects were expressed as odds ratio (OR) and their 95% confidence intervals (CIs). We evaluated publication bias through Egger's test and funnel plot. RESULTS A total of 12 cohort studies and 26 case-control studies were included, with 17076 patients. We found that the higher values of total cholesterol (TC), low-density lipoprotein (LDL), triglycerides, and lipoprotein(a) (Lp(a)) were associated with a higher risk of developing DFU (OR: 1.47, OR: 1.47, OR: 1.5, OR: 1.85, respectively). Otherwise, the lower values of HDL were associated with a higher risk of developing DFU (OR: 0.49). Publication bias was not found for associations between TC, HDL, LDL, or TG and the risk of DFU. CONCLUSIONS The high values of LDL, TC, TG, and Lp(a) and low values of HDL are associated with a higher risk of developing DFU. Furthermore, we did not find a significant association for VLDL, ApoA1, ApoB, and ApoB/ApoA1 ratio.
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Affiliation(s)
- Juan R. Ulloque-Badaracco
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
- Sociedad Científica de Estudiantes de Medicina de la Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Melany D. Mosquera-Rojas
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
- Sociedad Científica de Estudiantes de Medicina de la Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Enrique A Hernandez-Bustamante
- Sociedad Científica de Estudiantes de Medicina de la Universidad Nacional de Trujillo, Trujillo, Peru
- Grupo Peruano de Investigación Epidemiológica, Unidad para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
| | - Esteban A Alarcón-Braga
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
- Sociedad Científica de Estudiantes de Medicina de la Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | | | | | - Percy Herrera-Añazco
- Universidad Privada San Juan Bautista, Lima, Peru
- Instituto de Evaluación de Tecnologías en Salud e Investigación—IETSI, EsSalud, Lima, Peru
| | - Vicente A. Benites-Zapata
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru
| | - Adrian V. Hernandez
- Unidad de Revisiones Sistemáticas y Meta-Análisis, Guías de Práctica Clínica y Evaluaciones de Tecnología Sanitaria, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru
- Health Outcomes, Policy, and Evidence Synthesis (HOPES) Group, University of Connecticut School of Pharmacy, Mansfield, CT, USA
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Abstract
Dyslipidaemias are alterations to the plasma lipid profile that are often associated with clinical conditions. Dyslipidaemias, particularly elevated plasma LDL-cholesterol levels, are major risk factors for cardiovascular disease, but some forms, such as hypertriglyceridaemia, are associated with severe diseases in other organ systems, including non-alcoholic fatty liver disease and acute pancreatitis. Dyslipidaemias can be genetically determined (primary or familial dyslipidaemias) or secondary to other conditions (such as diabetes mellitus, obesity or an unhealthy lifestyle), the latter being more common. Hypercholesterolaemia is the most common form of dyslipidaemia and is associated with an increased risk of cardiovascular disease, with elevated plasma LDL-cholesterol levels being the 15th leading risk factor for death in 1990, rising to 11th in 2007 and 8th in 2019. The global burden of dyslipidaemias has increased over the past 30 years. Furthermore, the combination of high triglyceride levels and low HDL-cholesterol levels (together with the presence of small, dense LDL particles), referred to as atherogenic dyslipidaemia, is highly prevalent in patients with diabetes or metabolic syndrome and increases their risk of cardiovascular disease. Given the increasing prevalence of diabetes worldwide, treating lipid abnormalities in these patients might reduce their risk of cardiovascular disease.
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Watson S. Pharmacies in informal settlements: a retrospective, cross-sectional household and health facility survey in four countries. BMC Health Serv Res 2021; 21:945. [PMID: 34503501 PMCID: PMC8431901 DOI: 10.1186/s12913-021-06937-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Slums or informal settlements characterize most large cities in LMIC. Previous evidence suggests pharmacies may be the most frequently used source of primary care in LMICs but that pharmacy services are of variable quality. However, evidence on pharmacy use and availability is very limited for slum populations. METHODS We conducted household, individual, and healthcare provider surveys and qualitative observations on pharmacies and pharmacy use in seven slum sites in four countries (Nigeria, Kenya, Pakistan, and Bangladesh). All pharmacies and up to 1200 households in each site were sampled. Adults and children were surveyed about their use of healthcare services and pharmacies were observed and their services, equipment, and stock documented. RESULTS We completed 7692 household and 7451 individual adults, 2633 individual child surveys, and 157 surveys of pharmacies located within the seven sites. Visit rates to pharmacies and drug sellers varied from 0.1 (Nigeria) to 3.0 (Bangladesh) visits per person-year, almost all of which were for new conditions. We found highly variable conditions in what constituted a "pharmacy" across the sites and most pharmacies did not employ a qualified pharmacist. Analgesics and antibiotics were widely available but other categories of medications, particularly those for chronic illness were often not available anywhere. The majority of pharmacies lacked basic equipment such as a thermometer and weighing scales. CONCLUSIONS Pharmacies are locally and widely available to residents of slums. However, the conditions of the facilities and availability of medicines were poor and prices relatively high. Pharmacies may represent a large untapped resource to improving access to primary care for the urban poor.
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Affiliation(s)
| | - Sam Watson
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
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Lopez-Jaramillo P, Lopez-Lopez JP, Otero J, Alarcon-Ariza N, Mogollon-Zehr M, Camacho PA, Sanchez G, Narvaez C, Casanova M, Arcos E, Aroca G, Quintero A, Beaney T, Partington G, Poulter NR. May Measurement Month 2019: an analysis of blood pressure screening results from Colombia. Eur Heart J Suppl 2021; 23:B46-B48. [PMID: 34248430 PMCID: PMC8263072 DOI: 10.1093/eurheartj/suab039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Hypertension awareness and control is poor in low- and middle-income countries. Thus, implementing strategies to increase hypertension detection is needed. Colombia participated as one of the 92 countries involved in the third campaign of the May Measurement Month in 2019. Blood pressure (BP) was measured in 48 324 volunteers from 13 departments in Colombia. In total, 27.9% individuals were identified with hypertension. Of those with hypertension, 63.7% were aware of their condition, 60.0% were on antihypertensive medication, and 38.4% had controlled BP. These results showed low levels of awareness, treatment, and control of hypertension in this sample of subjects volunteered to participate, suggest the urgent necessity of implementing programmes to improve the diagnosis and management of hypertension in Colombia.
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Affiliation(s)
- Patricio Lopez-Jaramillo
- Instituto de Investigaciones Masira, Facultad de Ciencias de la Salud, UDES, Bucaramanga, Colombia
| | - Jose P Lopez-Lopez
- Instituto de Investigaciones Masira, Facultad de Ciencias de la Salud, UDES, Bucaramanga, Colombia
| | - Johanna Otero
- Instituto de Investigaciones Masira, Facultad de Ciencias de la Salud, UDES, Bucaramanga, Colombia
| | - Natalia Alarcon-Ariza
- Instituto de Investigaciones Masira, Facultad de Ciencias de la Salud, UDES, Bucaramanga, Colombia
| | - Margarita Mogollon-Zehr
- Instituto de Investigaciones Masira, Facultad de Ciencias de la Salud, UDES, Bucaramanga, Colombia
| | | | - Gregorio Sanchez
- Hospital San Juan de Dios Armenia, Universidad del Quindío, Armenia, Colombia
| | - Claudia Narvaez
- Departamento de Epidemiología, Hospital Susana López de Valencia, Popayán, Colombia
| | - Maria Casanova
- Programa de Medicina Interna, Universidad Libre, Cali, Colombia
| | - Edgar Arcos
- Fundación Centro de Obesidad y Metabolismo COMETA, Pasto, Colombia
| | - Gustavo Aroca
- Facultad de Medicina, Universidad Simón Bolívar and Clínica de la Costa, Barranquilla, Colombia
| | | | - Thomas Beaney
- Imperial Clinical Trials Unit, Imperial College London, London, UK
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Giles Partington
- Imperial Clinical Trials Unit, Imperial College London, London, UK
| | - Neil R Poulter
- Imperial Clinical Trials Unit, Imperial College London, London, UK
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Noubiap JJ. Clustering of cardiometabolic risk factors in sub-Saharan Africans. Pan Afr Med J 2021; 38:112. [PMID: 33912282 PMCID: PMC8051209 DOI: 10.11604/pamj.2021.38.112.28180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 12/03/2022] Open
Affiliation(s)
- Jean Jacques Noubiap
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
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Murphy A, Mbau L, McKee M, Hanson K, Torreele E. Can we do for other essential medicines what we are doing for the COVID-19 vaccine? BMJ Glob Health 2021; 6:e005158. [PMID: 33608320 PMCID: PMC7898227 DOI: 10.1136/bmjgh-2021-005158] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 01/30/2021] [Indexed: 01/14/2023] Open
Affiliation(s)
- Adrianna Murphy
- Centre for Global Chronic Conditions, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Martin McKee
- Centre for Global Chronic Conditions, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Kara Hanson
- Department of Global Health and Population, London School of Hygiene and Tropical Medicine, London, UK
| | - Els Torreele
- Institute for Innovation and Public Purpose, The Bartlett Faculty of the Built Environment, University College London, London, UK
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