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Aspirin use in middle-aged men with cardiovascular disease: are opportunities being missed?
A K McCallum1, P H Whincup, R W Morris
1Department of Primary Care and Population Sciences, Royal Free Hospital School of Medicine, London.
Insights
Despite evidence supporting aspirin for secondary cardiovascular disease (CVD) prevention, many British men with known CVD were not taking it. Aspirin use was lower in those with less recent events or no invasive treatment.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Clinical trials since the 1980s confirm aspirin's efficacy in secondary cardiovascular disease (CVD) prevention.
- Population-based studies are crucial for understanding real-world treatment adherence.
Purpose of the Study:
- To investigate the prevalence of aspirin use among British men diagnosed with established CVD.
- To identify factors associated with aspirin prescription in this patient cohort.
Main Methods:
- Utilized data from the British Regional Heart Study, a longitudinal population-based cohort.
- Assessed aspirin use via questionnaires in 1992 among 5751 men aged 52-73.
- Correlated aspirin use with diagnosed cardiovascular events up to October 1992.
Main Results:
- 9.5% of men reported daily aspirin use; 59% of these had documented CVD.
- Among men with prior myocardial infarction, stroke, or angina, 44%, 39%, and 29% respectively were on daily aspirin.
- Aspirin use was higher in patients who had undergone coronary artery bypass surgery (CABG) or angioplasty, and for more recent cardiovascular events.
Conclusions:
- A significant proportion of men with established CVD were not utilizing aspirin, despite its proven benefits.
- Lower aspirin uptake was observed in men with less recent major cardiovascular events and those who had not received revascularization procedures.
- Findings highlight potential gaps in secondary CVD prevention strategies within the UK population.
Background:
Since the 1980s, clinical trial evidence has supported aspirin use in the secondary prevention of cardiovascular disease (CVD).
Aim:
To explore aspirin use among British men with known CVD in a population-based study.
Method:
Longitudinal study (British Regional Heart Study), in which subjects have been followed up for cardiovascular morbidity and mortality since 1978-1980. Aspirin use was assessed by questionnaires to study participants in November 1992 (Q92); cardiovascular diagnoses are based on general practice notifications to October 1992. A total of 5751 men aged 52-73 years (87% of survivors) completed questions on aspirin use.
Results:
Overall, 547 men (9.5%) were taking aspirin daily, of whom 321 (59%) had documented CVD. Among men with pre-existing disease, 153 out of 345 (44%) men with myocardial infarction, 42 out of 109 (39%) with stroke, and 75 out of 247 (29%) with angina were taking aspirin daily. Among men with angina (54% versus 26%) or myocardial infarction (59% versus 42%), those who had undergone coronary artery bypass surgery (CABG) or angioplasty were more likely to be receiving aspirin. Higher rates of aspirin use were also found in those whose last major event occurred after January 1990 (47% versus 34%). There was no association between aspirin use and social class or region of residence.
Conclusion:
Despite strong evidence of its effectiveness, many patients with established CVD were not receiving aspirin. Daily aspirin treatment was less likely in men with less recent major CVD events and in those who had not received invasive treatment.