{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T05:18:10Z","timestamp":1790745490132,"version":"4.1.0"},"reference-count":45,"publisher":"American Medical Association (AMA)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2023,8,22]]},"abstract":"Importance<\/jats:title>Aspirin is an effective and low-cost option for reducing atherosclerotic cardiovascular disease (CVD) events and improving mortality rates among individuals with established CVD. To guide efforts to mitigate the global CVD burden, there is a need to understand current levels of aspirin use for secondary prevention of CVD.<\/jats:p><\/jats:sec>Objective<\/jats:title>To report and evaluate aspirin use for secondary prevention of CVD across low-, middle-, and high-income countries.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>Cross-sectional analysis using pooled, individual participant data from nationally representative health surveys conducted between 2013 and 2020 in 51 low-, middle-, and high-income countries. Included surveys contained data on self-reported history of CVD and aspirin use. The sample of participants included nonpregnant adults aged 40 to 69 years.<\/jats:p><\/jats:sec>Exposures<\/jats:title>Countries\u2019 per capita income levels and world region; individuals\u2019 socioeconomic demographics.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Self-reported use of aspirin for secondary prevention of CVD.<\/jats:p><\/jats:sec>Results<\/jats:title>The overall pooled sample included 124\u202f505 individuals. The median age was 52 (IQR, 45-59) years, and 50.5% (95% CI, 49.9%-51.1%) were women. A total of 10\u202f589 individuals had a self-reported history of CVD (8.2% [95% CI, 7.7%-8.6%]). Among individuals with a history of CVD, aspirin use for secondary prevention in the overall pooled sample was 40.3% (95% CI, 37.6%-43.0%). By income group, estimates were 16.6% (95% CI, 12.4%-21.9%) in low-income countries, 24.5% (95% CI, 20.8%-28.6%) in lower-middle-income countries, 51.1% (95% CI, 48.2%-54.0%) in upper-middle-income countries, and 65.0% (95% CI, 59.1%-70.4%) in high-income countries.<\/jats:p><\/jats:sec>Conclusion and Relevance<\/jats:title>Worldwide, aspirin is underused in secondary prevention, particularly in low-income countries. National health policies and health systems must develop, implement, and evaluate strategies to promote aspirin therapy.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jama.2023.12905","type":"journal-article","created":{"date-parts":[[2023,8,22]],"date-time":"2023-08-22T15:06:54Z","timestamp":1692716814000},"page":"715","source":"Crossref","is-referenced-by-count":29,"title":["Aspirin for Secondary Prevention of Cardiovascular Disease in 51 Low-, Middle-, and High-Income Countries"],"prefix":"10.1001","volume":"330","author":[{"given":"Sang Gune K.","family":"Yoo","sequence":"first","affiliation":[{"name":"Cardiovascular Division, Department of Internal Medicine, Washington University in St Louis, St Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace S.","family":"Chung","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silver K.","family":"Bahendeka","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, MKPGMS Uganda Martyrs University, Kampala, Uganda"},{"name":"St Francis Hospital, Nsambya, Kampala, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abla M.","family":"Sibai","sequence":"additional","affiliation":[{"name":"Epidemiology and Population Health Department, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albertino","family":"Damasceno","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique"},{"name":"Nucleo de Investiga\u00e7ao, Departamento de Medicina, Hospital Central do Maputo, Maputo, Mozambique"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farshad","family":"Farzadfar","sequence":"additional","affiliation":[{"name":"Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Rohloff","sequence":"additional","affiliation":[{"name":"Center for Indigenous Health Research, Wuqu\u2019 Kawoq, Tecp\u00e1n, Guatemala"},{"name":"Division of Global Health Equity, Brigham and Women\u2019s Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corine","family":"Houehanou","sequence":"additional","affiliation":[{"name":"Laboratory of Epidemiology of Chronic and Neurological Diseases, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bolormaa","family":"Norov","sequence":"additional","affiliation":[{"name":"Nutrition Department, National Center for Public Health, Ulaanbaatar, Mongolia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khem B.","family":"Karki","sequence":"additional","affiliation":[{"name":"Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammadreza","family":"Azangou-Khyavy","sequence":"additional","affiliation":[{"name":"Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maja E.","family":"Marcus","sequence":"additional","affiliation":[{"name":"Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krishna K.","family":"Aryal","sequence":"additional","affiliation":[{"name":"Bergen Centre for Ethics and Priority Setting in Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway"},{"name":"Public Health Promotion and Development Organization, Kathmandu, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luisa C. 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