Benefits of aspirin are not always taken to heart

Patients are often unaware of their risk for cardiovascular disease.

By Susan J. Landers — Posted March 14, 2005

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Washington -- Aspirin has been a premier pain reliever through the ages and, more recently, its heart-healthy benefits have been touted. But many of those who are candidates for physician-recommended aspirin therapy are not taking advantage of it, a new survey says.

Preliminary results from a Harris Interactive survey sponsored by the American College of Preventive Medicine found that 43% of adults age 40 and older who are at increased risk for heart attacks and strokes are not taking aspirin.

Although doctors and other health professionals say they are discussing aspirin's benefits with patients, not nearly enough patients are following this advice, said George K. Anderson, MD, MPH, ACPM past president.

Although cancer recently surpassed cardiovascular disease as the most common cause of death in the United States, 1.2 million Americans will have a first or recurrent heart attack this year, according to the Centers for Disease Control and Prevention. And prevention remains key to reducing that number.

Surveyors attributed one reason for the low use of aspirin to the fact that most people queried didn't know they were at an above-average risk for heart attacks and strokes.

Of the 1,299 men and women older than 40 who were surveyed, 42% were considered to be at increased risk in the next 10 years, yet only one-quarter of them realized it.

Those who would most benefit from aspirin therapy also are apparently not listening to their physicians. While nearly all health care professionals told surveyors that they are discussing the risks and benefits of aspirin therapy with the appropriate patients, many of those same patients said the discussions had not touched on aspirin's benefits.

This communications gap could explain why a smaller percentage of increased-risk respondents reported aspirin use (57%), compared with those reporting lifestyle changes (83%) and the use of prescription medications (79%).

The message that aspirin should be used more widely is not new, noted Steve Weisman, PhD, head of global health care products at Innovative Science Solutions in Morristown, N.J. "But it doesn't get the attention it deserves." Dr. Weisman discussed the survey findings at a Feb. 16 session of the ACPM's Preventive Medicine 2005 conference held in Washington.

"Right now I don't think we're doing a good job in practice or in public health of having individuals be aware of their coronary heart disease risk accurately," added Michael Pignone, MD, MPH, associate professor of medicine at the University of North Carolina at Chapel Hill School of Medicine.

Risks vs. benefits

But there are downsides to aspirin therapy, Dr. Pignone noted. Most notably, there is an increased risk of hemorrhagic stroke, but there is also increased risk for gastrointestinal bleeding and stomach discomfort.

In five large randomized trials, however, aspirin was found to reduce total coronary heart disease by about 28%, he said. "It's pretty clear there are benefits for reducing myocardial events."

The U.S. Preventive Services Task Force three years ago found sufficient evidence for aspirin's benefit to urge physicians to discuss aspirin therapy with the appropriate patients.

The American Heart Assn. also recommends aspirin for most patients who have had a heart attack, unstable angina, ischemic stroke or transient ischemic attacks.

And new research presented at the Second International Conference on Women, Heart Disease and Stroke reinforced the survey results by finding fewer than half of women with cardiovascular disease use aspirin.

Researchers examined data from the Women's Health Initiative Observational Study, which tracked nearly 100,000 post-menopausal women, singling out nearly 9,000 who had cardiovascular disease and should be taking aspirin along with other medications. They found that only 4,101 (46%) of the women with cardiovascular disease were on low-dose aspirin therapy and, among the 2,230 with documented heart attacks, only 54% reported using aspirin.

"Ideally, the percentage of women with a known history of cardiovascular disease who take aspirin should be above 90," said lead author Jeffrey S. Berger, MD, chief resident at Beth Israel Medical Center in New York.

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Aspirin advice

  • Decisions about aspirin therapy should take into account overall risk for coronary heart disease.
  • Risk assessment should include asking about the presence and severity of the following risk factors: age, sex, diabetes, elevated total cholesterol levels, low levels of high-density lipoprotein (HDL) cholesterol, hypertension, family history (in younger adults), and smoking.
  • Tools that incorporate specific information on multiple risk factors provide more accurate estimation of cardiovascular risk than categorizations based simply on counting the numbers of risk factors.

Source: U.S. Preventive Services Task Force recommendations on aspirin for the primary prevention of cardiovascular events, January 2002

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External links

U.S. Preventive Services Task Force recommendations on aspirin to prevent cardiovascular events (link)

American Heart Assn. (link)

Centers for Disease Control and Prevention on cardiovascular health (link)

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