By: Thomas Pickering, MD, DPhil, FRCP, Director of Integrative and Behavioral Cardiology Program
of the Cardiovascular Institute at Mount Sinai School of Medicine, New York.

Aspirin, as the TV commercials frequently remind us, is the “miracle drug” for people with coronary heart disease. It is proven to be effective at preventing heart attacks and strokes, is cheap, and relatively free of side effects. It is thus recommended that anyone who is known to have coronary heart disease should take a baby aspirin every day, unless there is a good reason not to (such as an allergic reaction to it, or stomach bleeding).

A study based on a series of national surveys of patients’ encounters with their physicians (the National Ambulatory medical Care Surveys) examined the use of aspirin in 10,942 patients who were diagnosed with coronary heart disease. The main finding was that aspirin use in these patients increased from 5% in 1980 to 26% in 1996. Since allowance was made for any contra-indications to taking aspirin, the ideal number would be 100%.

The study also examined why some people were more likely to be taking aspirin than others. Predictors of aspirin use included: male sex (women are generally treated less aggressively than men, for no good scientific reason); age less than 80 (even though older people should derive more benefit); smokers; and patients with high cholesterol levels (both of these increase the risk of heart disease, and hence the benefit from aspirin). Aspirin use was more likely to be reported if the patients were seeing a cardiologist as opposed to an internist or general practitioner.

Doctor’s Comments

The clear message from this study is that there are a lot of people who have a diagnosis of coronary heart disease who would benefit from taking aspirin, and who are not doing so, presumably because their doctors have not recommended it. The study did not address the use of aspirin by people who have high blood pressure but no known heart disease, for whom there are as yet no clear-cut recommendations. However, the HOT study found that in hypertensives whose blood pressure was well controlled the use of aspirin reduced the rate of heart attacks by 36%, although there was the expected increase of bleeding as a side effect.

Where it was published

RS Stafford. Aspirin use is low among United States outpatients with coronary artery disease. Circulation 2000; 101: 1097.