Aspirin Underemployed by Heart Patients

by Tina Adler

(5/16/00 HeartInfo) - In recent years, studies have demonstrated taking aspirin extends the life of heart disease patients, as it lowers the risk of heart attack or stroke. Nevertheless, a minority of heart patients are taking advantage of this inexpensive safeguard, a new study shows.

Aspirin use among heart patients increased from five percent in 1980 to only 26 percent in 1996, Dr. Randall S. Stafford of Massachusetts General Hospital in Boston reports in the March 13, 2000, Circulation. Since 1996, aspirin use has increased but is still below 40 percent, he told HeartInfo. Ideally, more than 80 percent of heart patients should be taking it, he asserts.

"Physicians may not be paying adequate attention to this important prevention strategy," he states in a press release.

For his study, Dr. Stafford examined how often cardiologists and other physicians prescribed aspirin or recommended its continuation during 10,942 appointments with heart disease patients. His data came from the National Ambulatory Medical Care Surveys. Other researchers found higher rates of aspirin use among heart patients than he did, but their sample was less broad, he notes.

Certain types of patients are more likely to be prescribed aspirin to protect their heart than are others, Dr. Stafford reports. Using data collected between 1993 and 1996 on a subset of 3,017 heart disease patients, he found the following rates of aspirin use:
  • 29 percent of male patients versus 21 percent of females,
  • 28 percent of patients under age 80 versus 17 percent of their elders,
  • 34 percent of smokers versus 25 percent of non-smokers (though this could be because more smokers were male than female),
  • 45 percent of patients with high cholesterol versus 24 percent of those
    with normal levels, and
  • 38 percent of cardiologists' patients versus 12 percent of general
    practitioners' patients.
Hospitalized patients are more likely than others to take aspirin to prevent second heart attacks, other studies show. Between 60 to 84 percent of hospitalized heart attack or angina patients receive aspirin, he notes.

Because aspirin is available without prescription, more patients may be taking it than doctors reported, Dr. Stafford writes. But the figures he has for aspirin use agree with usage figures for other types of over-the-counter medications recommended by doctors, such as prenatal vitamins, he said.

"Although the benefits of aspirin are most apparent in patients with acute myocardial infarction, long-term use is recommended for the secondary
prevention of all forms of coronary artery disease," the authors write.

Taking aspirin regularly can cause peptic ulcers, gastrointestinal bleeding, and allergic reactions, so don't take it without first talking to your doctor.

HeartInfo Commentary:

Studies show aspirin is the most effective drug available to prevent first heart attacks (primary prevention), reduce symptoms of angina and reduce the likelihood of a second heart attack. Aspirin will lengthen the life of grafts for bypass patients. And taking a single aspirin will decrease the risk of death by half for heart attack patients. For all these reasons, more heart patients should take aspirin.

Aspirin works by inhibiting a molecule called cyclooxygenase, which blocks the production of thromboxane, a chemical that causes platelets to clump together and form blood clots. 

Discuss aspirin therapy with your doctor if you have heart disease.

    --Circulation/MedscapeWire press release, March 14, 2000.

    --Massachusetts General Hospital press release, March 13, 2000.

    --Stafford, R.S., "Aspirin Use Is Low Among United States Outpatients With
    Coronary Artery Disease," Circulation, Volume 101, Number 10, pgs.1097-1101,
    March 14, 2000.


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