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Aspirin use has increased in patients who have heart disease, but underuse continues to be a concern

A recent study supported by the Agency for Healthcare Research and Quality (HS10548) found that the percentage of patients with heart disease who report taking aspirin regularly increased from 59 percent to 81 percent between 1995 and 1999. These results reflect substantial improvements in practice, but additional patients could benefit from this inexpensive, effective treatment that reduces deaths from heart disease, recurrent heart attacks, and strokes.

Researchers at one of seven AHRQ-supported Centers for Education and Research on Therapeutics (CERTs), the Duke University Medical Center, surveyed more than 25,000 patients from the Duke Databank for Cardiovascular Diseases. They examined trends in aspirin use, patient characteristics, and long-term outcomes for aspirin effectiveness.

According to the researchers, patients who didn't take aspirin to lower their risk of heart attack had nearly twice the risk of dying as those who took the drug regularly. Study findings show a number of clear characteristics that were predictors of aspirin use. Patients who were more likely to take the drug were younger males, nonsmokers, and those who had suffered prior heart attacks or undergone revascularization procedures in which clogged arteries were unblocked. Those who were unlikely to take aspirin regularly were patients with heart failure, diabetes, or hypertension. Clinical trials have consistently shown that patients who have diabetes benefit more from aspirin therapy than patients who do not have diabetes.

For more information, see "Underuse of aspirin in a referral population with documented coronary artery disease," by Robert M. Califf, M.D., Elizabeth R. DeLong, Ph.D., Truls Ostbye, M.D., M.Ph. and others, in the March 15, 2002 American Journal of Cardiology 89(6), pp. 653-661.

Editor's Note: The AHRQ-supported U.S. Preventive Services Task Force (USPSTF) recently issued a recommendation to clinicians to discuss the benefits and risks of aspirin therapy with healthy adults who are at risk of coronary heart disease. The USPSTF recommendation was published in the January 15 issue of the Annals of Internal Medicine.

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