Prevalence of cardiovascular medication on secondary prevention after myocardial infarction in China between 1995-2015: A systematic review and meta-analysis

BACKGROUND: Myocardial Infarction (MI) has become a major cause of morbidity and mortality in China, but little is known about the prevalence of guideline-recommended cardiovascular medications after MI events over the last two decades. This systematic review and meta-analysis aims to summarize cardiovascular medication use between 1995–2015 and to assess factors in associated with the trends in cardiovascular medications. METHOD: A systematic search was conducted in four databases (Pubmed, Embase, CENTRAL, and CNKI) to obtain observational studies published between 1995 and 2015, reporting on the use of cardiovascular medications in China. Risk of bias of individual studies was appraised and selected studies were pooled for estimated prevalence of cardiovascular medication. Prevalence of cardiovascular medication use for 1995 and 2015 was estimated by random effects meta-regression model. RESULTS: From 13,940 identified publications, 35 studies, comprising 28,000 patients, were included. The pooled prevalence for aspirin, beta-blockers, statins, ACE-Inhibitors, ACE-Inhibitor/ARBs and nitrates was 92% [95% confidence interval (CI): 0.89–0.95], 63% (95% CI: 0.57–0.69), 72% (95% CI: 0.60–0.82), 49% (95% CI: 0.41–0.57), 59% (95% CI: 0.48–0.69) and 79% (95% CI: 0.74–0.91), respectively. A significant increase in beta-blocker and statin use and a decrease of nitrate use was observed over time. The estimated prevalence of beta-blockers, statins, and nitrates was 78%, 91.1%, and 59.3% in 2015, compared to 32%, 17% and 96% in 1995, respectively. CONCLUSION: Cardiovascular medication use after MI is far from optimal in Chinese patients, even though the prevalence of use increased over the period 1995–2015. With a rapidly increasing number of MI patients in China, a comprehensive strategy on secondary prevention is warranted. SYSTEMATIC REVIEW REGISTRATION: PROSPERO (CRD42015025246)