Applicability of cardioprotective medication recommendations to people with multimorbidity and health inequalities (360G-Wellcome-323593_Z_24_Z)

Cardioprotective medications, including aspirin, antihypertensive agents, and statins, are pivotal in preventing cardiovascular disease. Evidence underpinning clinical guidelines predominantly comes from randomized clinical trials (RCTs). However, RCTs usually disproportionately or completely exclude vulnerable populations, such as older adults, ethnic minorities, individuals from socioeconomically disadvantaged backgrounds, and people with multimorbidity. Such disparities may lead to differences in prescribing practices, medication adherence, and variation in either treatment effectiveness or safety profiles. This project will use large electronic health record databases to investigate the applicability of cardioprotective medication guidelines to people with multimorbidity and other health inequalities typically excluded from RCTs. This will include evaluating guideline adherence among these populations, comparing demographics, clinical characteristics, and outcomes between people eligible and ineligible for RCTs, and assessing treatment effects. This research will critically appraise current guideline recommendations for cardioprotective medications in underrepresented populations, with a specific focus on individuals with multimorbidity and health inequalities. The findings aim to inform more inclusive and equitable clinical guidelines, identify gaps in existing evidence, and provide a foundation for future research targeting these underserved groups.