33 Prevalence of secondary prevention medication use in South America 2 patients and health care setting. It was a common finding that prevalence of cardioprotective medication use was lower in women (2,12,48,77), younger individuals (12,81). For example, male patients had an OR ranging from 1.29, (95%CI 1.11-1.49) to 1.54 (95%CI 1.06 – 2.24) for statin use compared to females (12,77); and patients aged 60 or older presented an OR ranging from 1.42 (95%CI,1.05-1.92) for the use of antiplatelet drugs (12) and 1.94 (1.07-3.50) for the use of cardioprotective medication in general (81). The presence of cardiovascular risk factors associated with higher medication use. The odds of medication use were higher for overweight (OR of ACEI/ARB use 2.56, 95%CI 1.74-3.77), obese (OR of ACEI/ARB use 2.96, 95%CI 2.00-4.38) and diabetic patients (OR of statin use 1.60, 95%CI 1.08-2.37) (12). Higher use of aspirin was identified among current (77) and former smokers (81), with OR of 1.83 (95%CI 1.35-2.50) and 1.41 (95%CI 1.03-1.93) respectively compared to non-smokers. High blood pressure was associated with higher use of betablockers and ACEI (OR 1.36, 95%CI 1.21-1.52, and 1.74, 95%CI 1.55-1.95 respectively), and high cholesterol with higher use of statins (OR 4.34, 95%CI 3.77-4.99) (77). A few articles identified the diagnosis category of CHD patients as determinant for medication use. Having a previous PCI was an independent determinant for higher use of antiplatelet drugs (OR 2.00, 95%CI 1.30-2.31) (2), and previous PCI or CABG were associated with higher use of statins (or 2.37, 95%CI 2.07-2.72) (77). One publication reported that patients who attended public centres (OR 1.99, 95%CI 1.54-2.59), or centres that are a combination of public and private (1.96, 95%CI 1.51-2.53) had higher odds of cardioprotective medication use (3) compared to those attending private centres. Lower SES (2,12,48,81) and living in rural areas (12) were also associated with lower medication use. In particular, participants from the wealthiest group had an OR of medication use of 2.54 (95%CI 1.08 – 5.95) for use of cardioprotective medication in general, to 5.94 (95%CI 2.80 – 12.6) for statin use compared to the least wealthy group (12,48); and urban dwellers had an OR of 1.41 (95%CI 1.04-1.92) for use of ACEI/ARB compared to participants from a rural location (12). Meta-regression results The health care setting, i.e. type of centre where the study had been conducted had a significant effect on medication prevalence for beta-blockers, statins, overall antiplatelet drugs and aspirin: the odds of medication use were lower in studies conducted in primary care and community settings compared to academic and tertiary centres. Further, the odds of overall antiplatelet drugs use were lower in public centres, and the odds of aspirin use were lower in cardiac rehabilitation settings, compared to academic and tertiary centres (Table 3).The use of ACEI/ARBs was not significantly associated with any of the covariates in the meta-regression models. The remaining medications or medication classes presented too few observations and thus meta-regression models could not be fit. The percentage of women included in the study and the previous CHD diagnosis category of the patient were not significantly associated with the use of any medication class. The
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