DALLAS, March 14 -- Too few Americans who have heart disease take aspirin to help prevent a recurrent heart attack and other cardiovascular problems, according to a report in today's Circulation: Journal of the American Heart Association.
The report found that only 26 percent of people who had heart disease and could have benefited from aspirin therapy took aspirin as recommended by the American Heart Association and other medical groups.
"That was much lower than what might be expected," says the study's author, Randall Stafford, M.D., Ph.D., assistant professor of medicine at Harvard Medical School and a senior scientist at Partners/Massachusetts General Hospital Institute for Health Policy in Boston. "It shouldn't necessarily be 100 percent because not everyone can take aspirin without developing complications; but it should be more than 26 percent.
"Physicians may not be paying adequate attention to this important prevention strategy," he adds. "Large numbers of patients with coronary artery disease are not being optimally managed, and their risk of having subsequent heart attacks and dying is increased because they are not on aspirin."
Regular aspirin use in people with heart disease has been shown to reduce the risk of blood clots that can block a heart artery and trigger a heart attack. The American Heart Association recommends that individuals who have experienced a heart attack or unstable angina -- a type of severe chest pain -- take aspirin to reduce the risk of another heart attack or hospitalization because of recurrent angina. Although aspirin may be beneficial in preventing heart disease in the first place, there is strong evidence of its benefit in patients who already have heart disease.
Because taking aspirin can pose some health risks -- including peptic ulcers, gastrointestinal bleeding and allergic reactions -- the Association warns that individuals should not take the drug without first consulting a physician.
The study's review of 10,942 doctor visits by people with heart disease revealed "a relatively dramatic" increase in the number of patients taking aspirin. Usage rose from 5 percent in 1980 to 26 percent in 1996.
Certain individuals were more likely to be taking aspirin as a preventive measure. More men than women took aspirin -- 29 percent versus 21 percent. A larger percentage of people younger than age 80 took aspirin -- 28 percent compared with 17 percent of those age 80 and older. People with high levels of cholesterol were nearly twice as likely to use aspirin as were those with normal levels -- 45 percent versus 24 percent.
"Although aspirin therapy in the most elderly may carry an increased risk of complications, aspirin is likely to have the greatest absolute benefit in this population," Stafford says. The finding of less aspirin use among women is "consistent with the observation that women may receive less aggressive treatment for coronary artery disease."
Stafford assessed national trends in the use of aspirin by non-hospitalized heart disease patients. He and his team examined data from the National Ambulatory Medical Care Surveys, which were conducted between 1980 and 1996, a period when the evidence for aspirin's benefit in reducing heart disease and stroke grew. The surveys provide information about the activities of a randomly selected group of cardiologists and primary care physicians in the United States during visits by patients to their offices.
Cardiologists were the most likely to report aspirin use by their patients. Approximately 38 percent of their patients took aspirin. That's compared to internists, whose rate of aspirin use in patients was 21 percent, family physicians whose rate was 18 percent, and general practitioners, whose rate of aspirin use was just 12 percent of patients.
Stafford says the study may underestimate the aspirin use of heart patients because physicians may not report the use of over-the-counter drugs. Also, patients might take aspirin without mentioning it to their physician.
However, he adds, "even if aspirin use is double what I found, and I don't believe it is even close to double, that would still suggest a problem of inadequate use."
NR00-1127 (Circ/Stafford)
Media advisory: Dr. Stafford may be reached by phone at (617) 724-4613, or by
e-mail at rstafford@partners.org. (Please do not publish numbers.)