SummaryBackgroundThere is little evidence on the use of secondary prevention medicines for cardiovascular disease by socioeconomic groups in countries at different levels of economic development.MethodsWe assessed use of antiplatelet, cholesterol, and blood-pressure-lowering drugs in 8492 individuals with self-reported cardiovascular disease from 21 countries enrolled in the Prospective Urban Rural Epidemiology (PURE) study. Defining one or more drugs as a minimal level of secondary prevention, wealth-related inequality was measured using the Wagstaff concentration index, scaled from −1 (pro-poor) to 1 (pro-rich), standardised by age and sex. Correlations between inequalities and national health-related indicators were estimated.FindingsThe proportion of patients with cardiovascular disease on three medications ranged from 0% in South Africa (95% CI 0–1·7), Tanzania (0–3·6), and Zimbabwe (0–5·1), to 49·3% in Canada (44·4–54·3). Proportions receiving at least one drug varied from 2·0% (95% CI 0·5–6·9) in Tanzania to 91·4% (86·6–94·6) in Sweden. There was significant (p<0·05) pro-rich inequality in Saudi Arabia, China, Colombia, India, Pakistan, and Zimbabwe. Pro-poor distributions were observed in Sweden, Brazil, Chile, Poland, and the occupied Palestinian territory. The strongest predictors of inequality were public expenditure on health and overall use of secondary prevention medicines.InterpretationUse of medication for secondary prevention of cardiovascular disease is alarmingly low. In many countries with the lowest use, pro-rich inequality is greatest. Policies associated with an equal or pro-poor distribution include free medications and community health programmes to support adherence to medications.FundingFull funding sources listed at the end of the paper (see Acknowledgments).

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Objective: To evaluate the nutritional status of hospitalized patients and the consumption of foods offered in the hospital and to assess the factors affecting their food consumption. Materials and Methods: Patients over 18, who were hospitalized in the internal medicine clinics for at least 72 hours and could take oral food, were included in the study. Patients’ anthropometric measurements, demographic characteristics, and current diseases were recorded, and NRS 2002 scores were calculated. The primary endpoint was to determine the patients' food consumption in the hospital and the reasons for insufficient consumption. The secondary endpoint was the comparison of the results according to the NRS score. Results: A total of 200 patients participated in the study. The mean age was 66±18 years. NRS≥3 was in 48% of patients (n=96) and the body mass index of these patients was lower than patients with NRS<3 (27±5 vs. 25±5; P= 0.002). They were older (60±18 vs. 73±14; p= 0.005), and their duration of hospitalization was longer (5±3 vs. 7±7; p= 0.03). In the group with NRS≥3, the rate of receiving nutritional support was 38.5%. In the whole group, the rate of consuming less than half of the hospital food was 75% and 86.5% in those with nutritional risk. When the factors affecting the preference of hospital meals were questioned, answers varied, such as not serving the food at the appropriate temperature, sour taste of the food, inconsistency of the foods on the menu in terms of taste and content. Only 4% of patients stated that they would prefer hospital menus as their diet menu at home. Conclusions: Half of the patients hospitalized in the internal medicine clinic are at risk of malnutrition. Nutritional support is also insufficient. To reduce inadequate food consumption during hospitalization, the causes should be analyzed, and measures should be taken.

Objective: To investigate the effect of SGLT2-i and GLP-1RA as an add-on therapy to metformin on weight loss and body composition, and to compare their effects on glucose and lipid parameters. Study Design: A descriptive study.

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