Global cardiovascular disease (CVD) burden is high and rising. Focussing on 45 low-income and middle-income countries (LMICs), we aimed to determine: i) the adult population’s median ten-year predicted CVD risk, including its variation within countries by socio-demographic characteristics; and ii) the prevalence of self-reported blood pressure (BP) medication use among those with and without an indication for such medication as per World Health Organization (WHO) guidelines.
Methods and Findings
Cross-sectional analysis of nationally representative household surveys from 45 LMICs carried out between 2005 and 2017, with 32 surveys being WHO Stepwise Approach to Surveillance (STEPS) surveys. Country-specific, median 10-year CVD risk was calculated using the 2019 WHO CVD Risk Chart Working Group non-laboratory based equations. BP medication indications were based on the WHO Package of Essential Non-Communicable Disease guidelines. Regression models examined associations between CVD risk, BP medication use and socio-demographic characteristics.
Complete case analysis included 600 484 adults from 45 countries. Median 10-year CVD risk (interquartile range (IQR)) for males and females was 2.7% (2.3 - 4.2) and 1.6% (1.3 - 2.1) respectively with the lowest estimates in Sub-Saharan Africa and highest in Europe and the Eastern Mediterranean. Higher educational attainment, greater household wealth, and current employment were associated with lower CVD risk in most countries. Of those indicated for BP medication, the median percentage taking medication was 24.2% (15.4 - 37.2) for males and 41.6% (23.9 - 53.8) for females. Conversely, almost half (47.1% [36.1 -58.6]) of all people taking a BP medication were not indicated for such based on CVD risk status. BP medication use and socio-demographic characteristics were not associated in most countries.
Study limitations include variation in country survey methods, most notably the sample age range and year conducted, insufficient data to use the laboratory-based risk equations, and an inability to determine past history of a CVD diagnosis.
This study found under-use of guideline-indicated medication in people with elevated CVD risk and relative over-use by people with lower CVD risk. Country-specific policies that improve the identification and management of those at highest risk are needed.