Health & FitnessScience

Heart drugs often unavailable or unaffordable

Cardiovascular disease drugs are often unavailable or unaffordable in many communities around the world, particularly in poorer countries, a recent study suggests.
Four types of medicines are recommended to help prevent deaths from cardiovascular disease: aspirin, beta blockers to control heart rhythm and lower high blood pressure (like atenolol or metoprolol, for example), drugs such as ACE inhibitors to relax blood vessels and improve blood flow (like captopril or enalapril, for instance) and statins to lower cholesterol (such as simvastatin or atorvastatin, or others).
To assess how easy it might be for people get to all four medicines, researchers looked at whether local pharmacies stocked all of the drugs and, if so, whether the combined cost was less than 20 percent of household income remaining after basic subsistence needs have been met.
The four medicines were available and affordable in most urban and rural communities in high-income countries, researchers reported in The Lancet.
But except for India, all of four drugs were available in low-income countries in only 25 percent of urban areas and 3 percent of rural communities.
In addition, these drugs were potentially unaffordable in 60 percent of low-income countries outside of India.
“The real unaffordability is even worse than what our paper suggests because it’s not just the pills, it is the amount of time off work, the cost to see the doctor, and the transportation cost,” said senior author Salim Yusuf, executive director of the Population Health Research Institute and professor at McMaster University in Hamilton, Ontario.
An estimated 17 million people worldwide die of cardiovascular disease each year, Yusuf and colleagues note.
The World Health Organization wants medicines for preventing cardiovascular disease to be available in 80 percent of communities and used by 50 percent of eligible individuals by 2025.
To see how the current reality measures up to this goal, the research team analyzed data on almost 95,000 households from nearly 600 communities in 18 countries – including about 7,000 people with cardiovascular disease.
In upper middle-income countries, the four medicines were available in 80 percent of urban and 73 percent of rural communities, the analysis found. But the drugs were unaffordable in 25 percent of these countries.
For lower middle-income nations, the drugs were all available in 62 percent of urban and 37 percent of rural areas but unaffordable in one third of the countries.
Access was better in India than in a typical low-income country, the study found. Here, the medicines were available in 89 percent of urban and 81 percent of rural communities – and affordable for 59 percent of households.
Louis Niessen and Jahangir Khan, health economists at the Center for Applied Health Research and Delivery at the Liverpool School of Tropical Medicine in the UK, write in an editorial that the findings highlight a problem that goes far beyond just the accessibility of medicines for cardiovascular disease.
That’s because families may lose work due to cardiovascular events, or suffer from additional diseases or injuries that are challenging to treat due to the cost or the unavailability of care close to home, they wrote.
“Our failure to provide health care for many leads to a lot of human suffering and loss of important adults in our lives as they die prematurely, up to ten to twenty years too early or remain with disability from stroke or from a more classical tropical condition,” Niessen said by email.

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