Secondary Prevention Medications in 17 Countries Grouped by Income Level (PURE): A Prospective Cohort Study

Section 1: Introduction (0:00 - 5:30) Dr. Valentin Fuster introduces a special issue on Prevention, covering societal and individual prevention aspects and key cardiovascular risk factors. He highlights issues like medication adherence, obesity, and the need for better education and healthcare systems. Section 2: Prevention in Society (5:30 - 35:30) Adherence to Medications The PURE trial shows low medication adherence (31% at follow-up) across 17 countries, despite technological advancements in diagnostics. Barriers include low health literacy and inadequate healthcare systems. Social Determinants of Health Social deprivation leads to worse cardiovascular outcomes, especially among sexual minorities in the U.S. The editorial calls for more equitable healthcare access and anti-stigma efforts. Environmental Factors: Aircraft Noise Higher aircraft noise exposure is linked to worse heart health, urging noise reduction policies for vulnerable populations. Section 3: Prevention in Individuals (35:30 - 55:30) Sedentary Behavior Even with exercise, high sedentary time (over 10.6 hours a day) increases cardiovascular risk. Reducing sedentary time can significantly lower heart disease risk. Intensive Lifestyle Interventions for Diabetes Weight loss and lifestyle changes improve cardiac biomarkers and reduce cardiovascular risk in type 2 diabetes patients. Section 4: Risk Factor Impacts (55:30 - 1:10:00) Hyperlipidemia & Obesity Hyperlipidemia and obesity management, including medications like semaglutide, play key roles in preventing cardiovascular disease. The 2024 ESC hypertension guidelines are also crucial in risk reduction.