Availability and Affordability of Cardiac Medications

Study Questions:

Does availability and affordability influence rates of effective cardiac medication use?


Availability and cost of four specific cardiac medications including aspirin, beta-blockers, angiotensin-converting enzyme inhibitors (ACEi), and statins were examined through data collected from pharmacies in 596 communities in 18 countries who participated in the PURE (Prospective Urban Rural Epidemiology) study. Data were collected between Jan. 1, 2003, and Dec. 31, 2013. Availability was based on the presence of the medication in the pharmacy when the pharmacy was surveyed. Medications were considered affordable if the combined cost was <20% of the household capacity to pay. Results were compared across high-income, upper middle-income, lower middle-income, and low-income countries. Data from India were presented separately given its large, generic pharmaceutical industry.


Data from 94,919 households with reported incomes from 596 communities in 18 countries were included. Availability of cardiovascular medications varied by income of the countries. All four cardiovascular disease (CVD) medicines were available in 61 (95%) of 64 urban and 27 (90%) of 30 rural communities in high-income countries, 53 (80%) of 66 urban and 43 (73%) of 59 rural communities in upper middle-income countries, 69 (62%) of 111 urban and 42 (37%) of 114 rural communities in lower middle-income countries, eight (25%) of 32 urban and one (3%) of 30 rural communities in low-income countries (excluding India), and 34 (89%) of 38 urban and 42 (81%) of 52 rural communities in India. The four CVD medicines were potentially unaffordable for 0.14% of households in high-income countries, 25% of upper middle-income countries, 33% of lower middle-income countries, 60% of low-income countries, and 59% of households in India. In low-income and middle-income countries, patients with previous CVD were less likely to use all four medicines if fewer than four were available (odds ratio [OR], 0.16; 95% confidence interval [CI], 0.04-0.57). In communities in which all four medicines were available, patients were less likely to use medicines if the household potentially could not afford them (OR, 0.16; 95% CI, 0.04-0.55).


The authors concluded that secondary prevention medications are unavailable or unaffordable for many communities in upper middle-income, lower middle-income, and low-income countries. Improvements in the availability and affordability of key medicines are likely to enhance their use.


These findings highlight the need to improve access to effective CV medication for all patients irrespective of income.

Clinical Topics: Dyslipidemia, Prevention, Nonstatins, Novel Agents, Statins

Keywords: Adrenergic beta-Antagonists, Angiotensin-Converting Enzyme Inhibitors, Aspirin, Cardiovascular Agents, Cardiovascular Diseases, Drug Industry, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Income, Poverty, Rural Population, Secondary Prevention

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