• Sang Gune K Yoo, Grace S Chung, Silver K Bahendeka, Abla M Sibai, Albertino Damasceno, Farshad Farzadfar, Peter Rohloff, Corine Houehanou, Bolormaa Norov, Khem B Karki, Mohammadreza Azangou-Khyavy, Maja E Marcus, Krishna K Aryal, Luisa C C Brant, Michaela Theilmann, Renata Cífková, Nuno Lunet, Mongal S Gurung, Joseph Kibachio Mwangi, Joao Martins, Rosa Haghshenas, Lela Sturua, Sebastian Vollmer, Till Bärnighausen, Rifat Atun, Jeremy B Sussman, Kavita Singh, Sahar Saeedi Moghaddam, David Guwatudde, Pascal Geldsetzer, Jennifer Manne-Goehler, Mark D Huffman, Justine I Davies, and David Flood.
• Cardiovascular Division, Department of Internal Medicine, Washington University in St Louis, St Louis, Missouri.
• JAMA. 2023 Aug 22; 330 (8): 715724715-724.

ImportanceAspirin 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.ObjectiveTo report and evaluate aspirin use for secondary prevention of CVD across low-, middle-, and high-income countries.Design, Setting, And ParticipantsCross-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.ExposuresCountries' per capita income levels and world region; individuals' socioeconomic demographics.Main Outcomes And MeasuresSelf-reported use of aspirin for secondary prevention of CVD.ResultsThe overall pooled sample included 124 505 individuals. The median age was 52 (IQR, 45-59) years, and 50.5% (95% CI, 49.9%-51.1%) were women. A total of 10 589 individuals had a self-reported history of CVD (8.1% [95% CI, 7.6%-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.Conclusion And RelevanceWorldwide, 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.

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