Cardiovascular diseases are a major public health problem in Russia, with mortality rates from CVD two to three times higher than in developed countries. CVD also have a significant economic impact in Russia, accounting for 80% of indirect costs from lost productivity. A global study found surprisingly low use of inexpensive medications for secondary prevention of CVD in both high- and low-income countries, representing a huge missed opportunity to help millions of people with heart disease.

1. Improving Health Outcomes through the
Secondary Prevention of Cardiovascular
Disease
The Importance of Access to
Medicines
Chris Ward June 2013

2. The Burden of NCDs in Russia

3. Socioeconomic Impacts of Cardiovascular
Diseases in Russia
Cardiovascular diseases (CVD) are a major public health and socioeconomic
problem in Russia
The standardized mortality rate from CVD in Russia is two to three times
higher than in developed countries.
A distinctive feature of CVD mortality in Russia is that most deaths due to
these causes occur in working age groups
This indirect damage is very important for Russia’s economy, as permanent
loss of the labor potential of the country is always a threat to the social and
economic welfare of a society
Source: Petrukhin IS, Lunina EY. Cardiovascular disease risk factors and mortality in Russia: challenges and
barriers. Public Health Reviews. 2012;33:436-49

4. Impact of Indirect Costs of CVD in Russia
• In 2009 the economic burden of
CVD in Russia is estimated to be
€24.4 billion
• 80% of the economic costs are
indirect - related to lost
productivity
• CVD economic losses are 3% of
GDP
Economic Burden of Cardiovascular Diseases in the Russian
Federation
Anna Kalinina & Anna Kontsevaya, Nartional Research Centre for
Preventive Medicine, Moscow

5. The Challenge of Changing Lifestyle
Behaviors
Despite the proven benefits of exercise, few people in Russia engage in
regular physical activity. In the European Union, only 31 percent of
respondents had a sufficient level of physical activity
Strategies for primary prevention of hypertension (lowering alcohol
consumption, healthy diet, weight control and physical activity) are important
but this needs to be combined with effective antihypertensive therapy.
Petrukhin IS, Lunina EY. Cardiovascular disease risk factors and mortality in Russia: challenges and
barriers. Public Health Reviews. 2012;33:436-49

6. Urgent Need to Address Management of
Hypertension
Petrukhin IS, Lunina EY. Cardiovascular disease risk factors and mortality in Russia: challenges and
barriers. Public Health Reviews. 2012;33:436-49
The contribution of hypertension to total mortality rates is about 35
percent.
Russian men and women with elevated systolic BP (> 180 mm Hg) live
12.2 years and 6.0 years less than those with normal BP.
The management of hypertension and development of health promotion
measures are critical to the further reduction of the mass premature
deaths due to CVD of Russian men and to a lesser extent women.

7. P.U.R.E. Study on Use of Medicines for
Secondary Prevention of CVD
Prospective Urban Rural Epidemiological study looked at the use of proven,
effective low-cost therapies for the secondary prevention of CDV throughout
the world.
The study included 154,000 adults between the ages of 35 and 70 with a
history of heart disease or stroke living in 17 high, middle and low-income
countries.
Data included use of medication, age, gender, education and key risk factors
such as smoking, diabetes, hypertension and obesity.
The study demonstrated that both in high and low-income countries there
was a surprising underuse of inexpensive and commonly available therapies
such as aspirin.
Use of secondary prevention drugs for cardiovascular disease in the community in high-income, middle-
income, and low-income countries (the PURE Study): a prospective epidemiological survey Salim Yusuf et al
www.thelancet.com Published online August 28, 2011 DOI:10.1016/S0140-6736(11)61215-4

8. The Underuse of Proven Low-Cost Medicines for
Secondary Prevention
Use of secondary prevention drugs for cardiovascular disease in the community in high-income, middle-
income, and low-income countries (the PURE Study): a prospective epidemiological survey Salim Yusuf et al
www.thelancet.com Published online August 28, 2011 DOI:10.1016/S0140-6736(11)61215-4

9. P.U.R.E. Study Conclusions: A Wasted
Opportunity
“Improvements to the uptake of effective secondary prevention strategies are
probably more feasible than are lifestyle modifications in primary prevention
(although both are desirable).”
These medicines are of proven benefit, are low cost and could significantly
improve the life expectancy of the Russian population that suffers from an
inordinately high mortality rate from cardiovascular diseases.
According to lead author Salim Yusuf "the data are extremely disturbing and
indicate a need for systematic efforts to understand why even inexpensive
medications are substantially under-utilized worldwide” …. “This is a global
tragedy and represents a huge wasted opportunity to help millions of people
with heart disease.
Use of secondary prevention drugs for cardiovascular disease in the community in high-income, middle-income,
and low-income countries (the PURE Study): a prospective epidemiological survey , Salim Yusuf et al
www.thelancet.com Published online August 28, 2011 DOI:10.1016/S0140-6736(11)61215-4

10. P.U.R.E. Study Conclusions: A Wasted
Opportunity
“Improvements to the uptake of effective secondary prevention strategies are
probably more feasible than are lifestyle modifications in primary prevention
(although both are desirable).”
These medicines are of proven benefit, are low cost and could significantly
improve the life expectancy of the Russian population that suffers from an
inordinately high mortality rate from cardiovascular diseases.
According to lead author Salim Yusuf "the data are extremely disturbing and
indicate a need for systematic efforts to understand why even inexpensive
medications are substantially under-utilized worldwide” …. “This is a global
tragedy and represents a huge wasted opportunity to help millions of people
with heart disease.
Use of secondary prevention drugs for cardiovascular disease in the community in high-income, middle-income,
and low-income countries (the PURE Study): a prospective epidemiological survey , Salim Yusuf et al
www.thelancet.com Published online August 28, 2011 DOI:10.1016/S0140-6736(11)61215-4