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Estimating the prevalence of aspirin use in the prevention of myocardial infarction

      The article by Lorenz et al
      • Lorenz D.P
      • Lee D.P
      • Alderman E
      Patterns of aspirin use before hospitalization for acute myocardial infarction.
      brings awareness to the underuse of aspirin in both primary and secondary prevention of cardiovascular disease; however, their analysis may overstate the magnitude of the problem. Because aspirin is effective at decreasing the risk of acute myocardial infarction, the prevalence of its antecedent use in a population of patients with acute myocardial infarction will be lower than the true frequency of its use in the community from which the cases came. To illustrate this, consider the extreme situation in which a treatment is completely effective at preventing acute myocardial infarction. The prevalence of use of such a treatment among a series of acute myocardial infarction cases would be 0 by definition.
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