Too Few Patients With Heart Disease Take Aspirin

From the WebMD Archives

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 Circulation.

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 stroke."

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."

Vital Information:

  • 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 taking it.
  • The use of aspirin has increased dramatically since 1980, but it is still at far less than recommended levels.