Philip JosephAlvaro AvezumChinthanie RamasundarahettigePrem K. MonyRita YusufKhawar KazmiAndrzej SzubaLOPEZ JARAMILLO, JOSÉ PATRICIOJOSÉ PATRICIOLOPEZ JARAMILLOMaria Luz DiazAfzal Hussein YusufaliSadi GulecRoya KelishadiLi WeiJephat ChifambaFernando LanasThandi PuoaneAmbigga KrishnapillaiSumathy RangarajanSalim YusufS. YusufS. RangarajanK.K. TeoS.S. AnandC.K. ChowM. O’DonnellE. SmithA. MenteD. LeongA. SmythP. JosephM. DuongA. KhetanH. KlimisR. D’SouzaV. MillerM. Walli-AttaeiS. IslamC. RamasundarahettigeS. BangdiwalaK. BalasubramanianG. WongN. JeyachandradhasX. YangC. TangL. FaragoM. ZarateJ. GodreaultM. HaskinsM. JethvaD. Nguyen-QuangA. PineauG. RigitanoA. VaghelaM. DehghanA. AlibertiA. ZakiB. ConnollyD. AgapayD. KrolF. ShifalyJ. RimacM. Di MarinoM. JakymyshynM. MushtahaN. KandyR. SolanoS. GopalS. RamachamN. ShimizuT. TonganaG. PareM. McQueenT. BryceR. DittaX. WangM. DiasRafael DiazAndres D. OrlandiniPablo LamelasMaria L. DiazAndrea L. PascualMauricio SalvadorCarolina ChaconJuan M. DominguezMohammad O. RahmanRita YusufSyed AKS. AhmedAfreen Z. KhanNazratun NayeemS.N. MitraShahidul IslamFuad PashaA. AvezumP. NevesR. NunesA.H.K. TriboniL.O. SantosE.R.P. SousaL.F.A. SilvaGustavo BF. OliveiraHamilton- Koon TeoRoxanna SolanoAaron DonstAlshey JacobGene LimBelise BideriBen ConnollyRizwana ButhoolSandy TrottierMarie-Ève PichéPaul PoirierGinette TurbideAnne Sophie BourlaudAudrey AuclairMyriam PettigrewScott A. LearRochelle A. NocosSydney K. LiAndreas WielgoszThais CoutinhoKaren N. SuarezSam J. Abbott-TateFernando LanasPamela SerónMaría J. OliverosFairuz CazorYazmin PalaciosJessica HidalgoCamilo AcostaLiu LishengLi WeiHu BoYin LuZhu JunLiang YanSun YiWang YangDeng QingWang XingyuCheng XiaoruWang ChuangshiLi SidongLiu WeidaLang XinyueLiu ZhiguangLA Tse ShellyHan GuoliangLu FanghongHou YanLiao XiaoyangChen DiZhang PengLi NingLei RenshengFu MinfanLiu YuXing XiaojieYang YouzhuXiang QuanyongTang JinhuaLiu ZhengrongQiang DerenHan AiyingYang JinkuiWu XinbinLiu ChunmeiHe GuominZhao QianResalaiti AobulikasimuWang HuiZhi YahongWang YaliMa HaibinMa YuantingHu LihuaZhang LiLiu GuoqingWang JunyingJin HuiYou KaiPeng TaoSu JingZhao YingxinPatricio Lopez-JaramilloPaul Anthony CamachoMaritza Perez-MayorgaJohanna Otero-WandurragaCarlos Cure-CureJose Luis AcciniEdgar ArcosCaludia NarvaezAristides SotomayorHenry GarciaGregorio Sanchez-VallejoFresia CotesJose Patricio Jopez-LopezDarly EspinosaMaria Angelica MuñozOlga Lucia BelloMaria L. Chacon-ManosalvaJulieth Tatiana Vasquez-ArcilaPrem K. MonyMario VazSumathi SwaminathanAnkalmadagu V. BharathiKiruba ShankarAnura V. KurpadKrishnaswamy G. JayachitraRaju AnthonyKaramala MuraliChengi BalajiKrishnappa AmaranadhPonnuswamy VijayalakshmiSiddaraju MonishaSiddayana S. HarshithaSubramani KirubaSirana SandhyaMittoor WoohaNitesh KumarViswanathan MohanRanjit Mohan AnjanaMohan DeepaKumar ParthibanLakshmanan DhanasekaranSundaram SureshkumarManivel NandhakumarMunusamy KumarDoss KalaivaniElumalai KarthickNarendra Sai AjithRajeev GuptaIndu MohanRooma BhargavaMadhusudan SharmaDevendra SharmaRaman Kutty VelappallilVijayakumar KrishnapillaiSanjeev NairKamala RammohanManu Muraleedharan SarojiniArunlal Anitha Rajappan NairVeena VeenaDivya SanthakumariSucharitha KamalamJith SreeranganRajesh KumarManmeet KaurPinnaka Venkata Maha LakshmiVivek SagarRupali MahajanRupinder SinghKamaljeet SinghKamaldev SharmaBabita ChauhanKamaldeep SinghRoya KelishadiAhmad BahonarNoushin MohammadifardHossein HeidariKairat DavletovBatyrbek AssembekovBauyrzhan AmirovErkin MirrakhimovSaamay AbilovaUmid ZakirovUlan ToktomamatovErkaiym BektashevaAzamat AsanbaevNursultan AsanalievRysbek Mamat uuluKhalid YusoffTengku Saifuddin Tengku IsmailKien Keat NgAmbigga Devi DeviNafiza Mat-NasirAnis Safura RamliNorashikin Mohamed Nor-AshikinRazif DasimanYasin Md MazapuspavinaFarnaza AriffinMaizatullifah MiskanHasidah Abdul-HamidSuraya Abdul-RazakNik Munirah Nik Mohd-NasirSiti Fatimah Badlishah-ShamMohamed Syarif Mohamed-YassinFadhlina MajidNajmin Abu BakarNurhaliza ZainonRasyidah SallehNurshamin Mohd GhazaliMardhiah BaharomHazimah ZulkifliRafezah RazaliSarina AliBoon Peng HohNoorhassim IsmailMohd Hasni JaafarAzmi Mohd TamilZaleha Md IsaRosnah IsmailKhairul Hazdi YusofNoraidah SaianNurul Afifah JusohNur Nadia MohamedFarah Adilla FauziFatin Azierah Fauzi Siti Norzulikha RahimRasha KhatibUmaiyeh KhammashRita GiacamanRomaina IqbalRehman KhawajaKhawar KazmiShehzad AliMuhammad AsimMohan JummaSana BachalHina SharifNighat AlmasJaime MirandaAntonio Bernabe OrtizWilliam CheckleyGermán MálagaRobert H. GilmanRodrigo M. Carrillo-LarcoMaría Lazo-PorrasLia M. Palileo-VillanuevaAntonio L. DansMarc Evans M. AbatLouie P. PudolChareece Z. PudolMadenn S. SegarraMary Joy S. RomeroCharlene C. AbaquinKristaleen Mae ManguiatMary Stephanie MalayangAndrzej SzubaKatarzyna ZatonskaAlicja Basiak-RasałaKatarzyna Poltyn -ZaradnaMaria WolyniecOlga L. BarbarashGalina V. ArtamonovaElena V. IndukaevaEvgeny D. BazdyrevOlga M. PolikutinaOlga V. GruzdevaDaria P. TsygankovaTamara A. VinichenkoOlga V. NachratovaAlyena S. AgienkoYulia S. ShotK.F. AlHabibM.Q. AlshamiriH.B. AltaradiM. AbdulrahmanR. NouriIolanthé M. KrugerAletta E. SchutteEdelweiss Wentzel-ViljoenThandi PuoaneRina SwartEhimario IgumborLungiswa P. TsolekileNasheeta PeerBonaventure A. EgbujieA. RosengrenA. GustavssonM. AndreassonJ Kembro JohanssonI. SegerqvistM. LindgrenKaren YeatesOresto MunishiNicola WestGissela NyakungaAytekin OguzNese ImeryuzYuksel AltuntasAhmet TemizhanKubilay KarsidagBurcu T. CalikArzu K. AkalinOzge T. CakliliMirac V. KeskinlerKubra Yildiz GulerAfzalhussein M. YusufaliMadiha H.S. AbdelmotagaliDouaa F. YoussefOlfat Z.S. AhmadSuad H. AhmedMaryam A. AlOmairiHamda H. KhansahebWadeia M. ShariefManal O. TaryamMarwan ZidanOlfat Z.S. AhmadEman F. El-SayedMai H. AwadallaMagdy M. HassanNadia SalehZahid N. QurechiRaed M. Abu KafJessy P. IthappiriSavithri GovindashettigarLourdu J. AdeleJephat ChifambaTatenda NcubeBrian NcubeCasper ChimheteTavengwa ManenjiLennon Gwaunza2025-08-042025-08-042025-02https://doi.org/10.1016/j.jacc.2024.10.121Background: It is unclear whether global use of medications for secondary cardiovascular (CVD) prevention is improving over time. Objectives: This study across 17 high-, middle- and low-income countries described variations in secondary CVD prevention medication use over a median follow-up of 12 years. Methods: In the multinational PURE (Prospective Urban Rural Epidemiology) cohort study, we conducted a repeated cross-sectional analysis to examine temporal variations in the use of secondary prevention medications in participants with CVD. In participants with coronary artery disease, we focused on antiplatelet agents, statins, renin-angiotensin system (RAS) inhibitors, and β-blockers. In participants with stroke, we focused on antiplatelet agents, statins, RAS inhibitors, and other blood pressure–lowering drugs. Medications were collected at baseline and on 4 subsequent follow-up visits. Results: The analysis included 7,409 participants with a diagnosis of CVD at the baseline visit, 8,792 at the second visit, 9,236 at the third visit, 11,082 at the fourth visit, and 11,677 at the last visit. The median age at baseline was 58.0 years, and 52.9% of the participants were female. The median follow-up was 12 years, with the median year of the baseline visit in 2007 and the fifth visit in 2019. Over this period, use of 1 or more classes of medications for secondary CVD prevention was 41.3% (95% CI: 40.2%-42.4%) at baseline, peaked at 43.1% (95% CI: 42.0%-44.1%), and then decreased to 31.3% (95% CI: 30.4%-32.1%) by the last study visit. In high-income countries, this use decreased from 88.8% (95% CI: 86.6%-91.0%) to 77.3% (95% CI: 74.9%-79.6%). In upper-middle-income countries, this use increased from 55.0% (95% CI: 52.8%-57.3%) to 61.1% (95% CI: 59.1%-63.1%). In lower-middle-income countries, use of at least 1 class of medications was 29.5% (95% CI: 28.1%-30.9%) at baseline, peaked at 31.7% (95% CI: 30.4%-33.1%), and then decreased to 13.4% (95% CI: 12.5%-14.2%) by the last visit. In low-income countries, use of at least 1 class of medications was 20.8% (95% CI: 18.1%-23.5%) at baseline, peaked at 47.3% (95% CI: 44.8%-49.9%), and then decreased to 27.5% (95% CI: 25.2%-29.9%) by the last study visit. Conclusions: Globally and in most country income-level groups, the use of medications for secondary CVD prevention has been low, with little improvement over time.encardiovascular diseasecoronary artery diseasemedication usestrokejournal-article