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Aspirin Underused in US Adults

Posted: Thursday, May 03, 2007

A nationwide survey of adults over the age of 40 has found that only 41% say they regularly take aspirin.

The survey included 1299 adults with a mean age of 56, who provided information about their aspirin use, cardiovascular risk factors, perceptions of risks and benefits of aspirin, and whether they had had discussions with their doctors or healthcare providers about aspirin therapy. Based on self-reported risk factors queried in the survey, 42% of respondents were estimated to be at increased risk for CVD, yet agreement between subjective heart-attack risk and objective, self-reported risk factors for CVD was low. A full 28% of survey participants with low subjective risk had increased risk factors, while 44% of those who believed themselves to be "high risk" were not in fact at risk based on CVD risk-factor profile. By contrast, of those at higher risk, objectively, more than one quarter believed their risk was low.

So while the proportion of people taking aspirin was actually similar to the number of people at increased risk, the people who needed aspirin were not always taking it. Still, people who believed they were at high risk for a heart attack were more likely to be taking aspirin than those who believed their heart-attack risk was low. The same held true for people with risk factors for CVD, compared with people with minimal CVD risk factors, but numbers were still suboptimal for people at risk, the authors say.

Proportion of survey respondents who take aspirin regularly:

Group % using aspirin

>65 years old 56

<65 years old 36

High subjective risk of MI 51

Low subjective risk of MI 32

Objective increased risk of CVD 57

Objective low risk of CVD 30

One of the factors most strongly associated with aspirin use was a discussion with a healthcare provider about its use--88% of the 41% of people who said they took aspirin regularly also said they had discussed aspirin use with their doctors. Overall, however, only 33% of those surveyed said they had discussed aspirin and its risks/benefits with a healthcare provider.

Senior author, Dr Steven M Weisman (Innovative Science Solutions, Morristown, NJ), stated that, "We had the belief that physicians would have a great understanding of the benefits of aspirin and would be talking to their patients about it." "So we were somewhat surprised to find that while a very large number of physicians felt favorably about aspirin and used it themselves or said they recommended it, a very large number of patients actually left the office not hearing that recommendation or not feeling they got it at all. And I think we would have expected to see numbers more in the 70% range than the 40% that we did see."

The study could not address whether physicians might have actually counseled their patients about aspirin and that advice wasn't heard or understood or whether physicians are actually forgetting to mention aspirin.

"The take-home message is that aspirin is an important therapy in preventive cardiovascular care, and for patients to get the benefit that they can get from use, the physician needs to be much more forceful in his or her recommendations and also be very engaged in follow-up to ensure that people are using it appropriately and deriving a benefit," Weisman commented. "And clearly if that happens, there will be a commensurate reduction in cardiovascular events and improvement in mortality, which is the goal of all involved."

Source: Diabetes In Control: Weisman disclosed providing consulting services for pharmaceutical companies, including Bayer. Pignone M, Anderson GK, Binns K, et al. Aspirin use among adults over 40 in the US: Results of a national survey. Am J Prev Med 2007; 32:403-407