Too Few Patients With Heart Disease Take Aspirin
March 13, 2000 (Minneapolis) -- Far too few patients with heart disease are
taking aspirin, even though the drug can help prevent further heart attacks and
strokes, a new study says.
"Patients who have heart disease, and who are not on aspirin, need to
ask physicians if they should be taking it," says Randall S. Stafford, MD,
PhD. "Patients who are told to take aspirin should do it." Stafford is
an assistant professor of medicine at Harvard Medical School and a senior
scientist at the Institute for Health Policy at Partner/Massachusetts General
Hospital in Boston. His study was published in the journal
Aspirin is recommended for all patients who have had heart attacks, unless
there is some reason they can't take it, such as an allergy. Studies have
consistently found it to reduce these patients' risk of having another heart
attack or stroke.
Stafford reviewed the records of more than 10,000 doctor visits of heart
disease patients from 1980 to 1996. Aspirin use among these patients, he
writes, increased from 5% to about 26% during that time. But experts say this
rate is still disturbingly low.
"This is the first comprehensive study I've seen that looks at the
consumption of aspirin in the target population, and the findings are
distressing," says Richard A. Levinson, MD, DPA, who reviewed the article
for WebMD. "The numbers should be closer to 100%."
"The public needs to know that an exhaustive number of studies have
shown the role of aspirin in secondary prevention," says Levinson, who is
associate executive director of the American Public Health Association.
"It's a safe and effective way to prevent additional [heart attack] or
Female heart patients and those over 80 were less likely to be taking
aspirin, according to the study. It found that 29% of men with coronary artery
disease took the drug, compared to 21% of women. Among patients aged 65 to 79,
about 26% were aspirin users, compared to 17% of those 80 and up. Smokers,
people with elevated cholesterol, and those who had private insurance were also
more likely to use aspirin.
The likelihood that patients would take aspirin also depended on what type
of doctor they saw, the study found. Cardiologists reported that 38% of their
patients took aspirin, while internists put the figure at 21% and family
physicians at 18%. "This ... suggests that aspirin use in patients with
coronary artery disease has not become a widely disseminated practice in the
United States," Stafford writes.
The low rates found by the study may be due in part to an underreporting of
aspirin use by doctors and patients. And that in itself may show that too
little attention is being paid to aspirin therapy, Stafford says.
"Because aspirin is inexpensive and available, it's possible that
physicians are failing to report aspirin use, and patients may be taking it but
not reporting it to their physicians," Stafford tells WebMD.
This would be troubling, he said, "because it would indicate that
neither physicians nor patients are taking preventive aspirin therapy
seriously. Even though this medicine is old, inexpensive, and available over
the counter, it has a critical role."
- Although aspirin is recommended for many patients with heart disease, only
26% of such patients are taking it.
- Aspirin is a safe and effective way to prevent a second heart attack or
stroke, and heart disease patients should ask their doctors if they should be
- The use of aspirin has increased dramatically since 1980, but it is still
at far less than recommended levels.