Advertisement

Comparison of the Racial/Ethnic Prevalence of Regular Aspirin Use for the Primary Prevention of Coronary Heart Disease from the Multi-Ethnic Study of Atherosclerosis

      In 2002, the United States Preventive Services Task Force and the American Heart Association recommended aspirin for the primary prevention of coronary heart disease in patients with Framingham risk scores ≥6% and ≥10%, respectively. The regular use of aspirin (≥3 days/week) was examined in a cohort of 6,452 White, Black, Hispanic, and Chinese patients without cardiovascular disease in 2000 to 2002 and 5,181 patients from the same cohort in 2005 to 2007. Framingham risk scores were stratified into low (<6%), increased (6% to 9.9%), and high (≥10%) risk. In 2000 to 2002 prevalences of aspirin use were 18% and 27% for those at increased and high risk, respectively. Whites (25%) used aspirin more than Blacks (14%), Hispanics (12%), or Chinese (14%) in the increased-risk group (p <0.001). Corresponding prevalences for the high-risk group were 38%, 25%, 17%, and 21%, respectively (p <0.001). In 2005 to 2007 prevalences of aspirin use were 31% and 44% for those at increased and high risk, respectively. Whites (41%) used aspirin more than Blacks (27%), Hispanics (24%), or Chinese (15%) in the increased-risk group (p <0.001). Corresponding prevalences for the high-risk group were 53%, 43%, 38%, and 28%, respectively (p <0.001). Racial/ethnic differences persisted after adjustment for age, gender, diabetes, income, and education. In conclusion, regular aspirin use in adults at increased and high risk for coronary heart disease remains suboptimal. Important racial/ethnic disparities exist for unclear reasons.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • US Preventive Services Task Force
        Aspirin for the primary prevention of cardiovascular events: recommendation and rationale.
        Ann Intern Med. 2002; 136: 157-160
        • Pearson T.A.
        • Blair S.N.
        • Daniels S.R.
        • Eckel R.H.
        • Fair J.M.
        • Fortmann S.P.
        • Franklin B.A.
        • Goldstein L.B.
        • Greenland P.
        • Grundy S.M.
        • Hong Y.
        • Miller N.H.
        • Lauer R.M.
        • Ockene I.S.
        • Sacco R.L.
        • Sallis J.F.
        • Smith Jr, S.C.
        • Stone N.J.
        • Taubert K.A.
        AHA guidelines for primary prevention of cardiovascular disease and stroke: 2002 update: consensus panel guide to comprehensive risk reduction for adult patients without coronary or other atherosclerotic vascular diseases.
        Circulation. 2002; 106: 388-391
        • Franco O.H.
        • der Kinderen A.J.
        • De Laet C.
        • Peeters A.
        • Bonneux L.
        Primary prevention of cardiovascular disease: cost-effectiveness comparison.
        Int J Technol Assess Health Care. 2007; 23: 71-79
        • Steering Committee of the Physicians' Health Study Research Group
        Final report on the aspirin component of the ongoing Physicians' Health Study.
        N Engl J Med. 1989; 321: 129-135
        • Medical Research Council's General Practice Research Framework
        Thrombosis prevention trial: randomised trial of low-intensity oral anticoagulation with warfarin and low-dose aspirin in the primary prevention of ischaemic heart disease in men at increased risk.
        Lancet. 1998; 351: 233-241
        • Collaborative Group of the Primary Prevention Project
        Low-dose aspirin and vitamin E in people at cardiovascular risk: a randomised trial in general practice.
        Lancet. 2001; 357: 89-95
        • Hansson L.
        • Zanchetti A.
        • Carruthers S.G.
        • Dahlof B.
        • Elmfeldt D.
        • Julius S.
        • Ménard J.
        • Rahn K.H.
        • Wedel H.
        • Westerling S.
        Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial.
        Lancet. 1998; 351: 1755-1762
        • Rodondi N.
        • Vittinghoff E.
        • Cornuz J.
        • Butler J.
        • Ding J.
        • Satterfield S.
        • Newman A.B.
        • Harris T.B.
        • Hulley S.B.
        • Bauer D.C.
        Aspirin use for the primary prevention of coronary heart disease in older adults.
        Am J Med. 2005; 118 (e1–1288.e9): 1288
        • Stafford R.S.
        • Monti V.
        • Ma J.
        Underutilization of aspirin persists in US ambulatory care for the secondary and primary prevention of cardiovascular disease.
        PLoS. 2005; 2: 1292-1298
        • Bild D.E.
        • Bluemke D.A.
        • Burke G.L.
        • Detrano R.
        • Diez Roux A.V.
        • Folsom A.R.
        • Greenland P.
        • Jacobs Jr, D.R.
        • Kronmal R.
        • Liu K.
        • Nelson J.C.
        • O'Leary D.
        • Saad M.F.
        • Shea S.
        • Szklo M.
        • Tracy R.P.
        Multi-ethnic study of atherosclerosis: objectives and design.
        Am J Epidemiol. 2002; 156: 871-881
        • Expert Committee on the Diagnosis and Classification of Diabetes Mellitus
        Follow-up report on the diagnosis of diabetes mellitus.
        Diabetes Care. 2003; 26: 3160-3167
        • Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults
        Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III).
        JAMA. 2001; 285: 2486-2497
        • D'Agostino Sr, R.B.
        • Grundy S.
        • Sullivan L.M.
        • Wilson P.
        Validation of the Framingham coronary heart disease prediction scores: results of a multiple ethnic groups investigation.
        JAMA. 2001; 286: 180-187
        • Ridker P.M.
        • Cook N.R.
        • Lee I.
        • Gordon D.
        • Gaziano J.M.
        • Manson J.E.
        • Hennekens C.H.
        • Buring J.E.
        A randomized trial of low-dose aspirin in the primary prevention of cardiovascular disease in women.
        N Engl J Med. 2005; 352: 1293-1304
        • Greving J.P.
        • Buskens E.
        • Koffijberg H.
        • Algra A.
        Cost-effectiveness of aspirin treatment in the primary prevention of cardiovascular disease events in subgroups based on age, gender, and varying cardiovascular risk.
        Circulation. 2008; 117: 2875-2883
        • Mosca L.
        • Banka C.L.
        • Benjamin E.J.
        • Berra K.
        • Bushnell C.
        • Dolor R.J.
        • Ganiats T.G.
        • Gomes A.S.
        • Gornik H.L.
        • Gracia C.
        • Gulati M.
        • Haan C.K.
        • Judelson D.R.
        • Keenan N.
        • Kelepouris E.
        • Michos E.D.
        • Newby L.K.
        • Oparil S.
        • Ouyang P.
        • Oz M.C.
        • Petitti D.
        • Pinn V.W.
        • Redberg R.F.
        • Scott R.
        • Sherif K.
        • Smith Jr, S.C.
        • Sopko G.
        • Steinhorn R.H.
        • Stone N.J.
        • Taubert K.A.
        • Todd B.A.
        • Urbina E.
        • Wenger N.K.
        Evidence-based guidelines for cardiovascular disease prevention in women: 2007 update.
        Circulation. 2007; 115: 1481-1501
        • Nasir K.
        • Michos E.D.
        • Blumenthal R.S.
        • Raggi P.
        Detection of high-risk young adults and women by coronary calcium and national cholesterol education program panel III guidelines.
        J Am Coll Cardiol. 2005; 46: 1931-1936
        • Blumenthal R.S.
        • Michos E.D.
        • Nasir K.
        Further improvements in CHD risk prediction for women.
        JAMA. 2007; 297: 641-643
        • US Preventive Services Task Force
        Aspirin for the prevention of cardiovascular disease: U.S. preventive services task force recommendation statement.
        Ann Intern Med. 2009; 150: 396-404
        • Stafford R.S.
        Aspirin use is low among United States outpatients with coronary artery disease.
        Circulation. 2000; 101: 1097-1101