http://www.theheart.org/web_slides/1283911.do A survey of 153,996 adults on prospective urban rural epidemiology (PURE) to examine the relationship of societal influences on human lifestyle behaviors, CV risk factors, and incidence of chronic non communicable diseases

1. PURE (Prospective Urban Rural
Epidemiology)

2. PURE (Prospective Urban Rural Epidemiology)
S Yusuf (McMaster University, Hamilton, ON)
European Society of Cardiology 2011 Congress
• A survey of 153 996 adults to examine the relationship of societal influences on
human lifestyle behaviors, CV risk factors, and incidence of chronic
noncommunicable diseases
• Time period: 2003–2009
• Population categories:
Urban and rural communities in countries categorized as high-income
(Canada, Sweden, and United Arab Emirates), upper-middle-income
(Argentina, Brazil, Chile, Malaysia, Poland, South Africa, and Turkey), lower-
middle-income (China, Colombia, and Iran), and low-income (Bangladesh,
India, Pakistan, and Zimbabwe)
• Analyzed the use of antiplatelets, beta blockers, ACE inhibitors or ARBs,
statins, and other agents among persons with CHD or stroke
ACE=angiotensin-converting enzyme; ARB=angiotensin receptor blocker; CHD=coronary heart
disease

3. PURE: Results (by economic status)
CV drug use for secondary prevention among patients with CHD or
stroke, by nation economic status
CV drug category High-income (%) Upper-middle Lower-middle Low-income Overall
income (%) income (%) (%)
Antiplatelets 62.0 24.6 21.9 8.8 25.3
Beta blockers 40.0 25.4 10.2 9.7 17.4
ACE inhibitors or ARBs 49.8 30.0 11.1 5.2 19.5
BP-lowering agents 73.8 48.4 37.4 19.2 41.8
Statins 66.5 17.6 4.3 3.3 14.6
All decreasing trends from higher- to lower-income, p<0.0001

4. PURE: Results (urban vs rural)
CV drug use for secondary prevention among patients with CHD or
stroke, urban vs rural populations across all surveyed countries
CV drug category Urban (%) Rural (%)
Antiplatelets 27.7 21.5
Beta blockers 20.3 13.1
ACE inhibitors or ARBs 22.3 15.4
BP-lowering agents 47.1 33.7
Statins 17.2 10.6
All differences urban vs rural, p<0.001

5. PURE: Commentary*
"These are the cheapest, the safest, and the most effective drugs. And yet we have
a collective global failure."
- Dr Salim Yusuf
"A real improvement in global cardiovascular health could likely be obtained through
preventive strategies focused on the well-known risk factors, including lifestyle
changes."
- Dr Aldo Pietro Maggioni
*All comments from PURE: CV drugs underused in poor nations, rural populations
(http://www.theheart.org/article/1268617.do)

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