March 24, 2000

An MGH study found that despite evidence that aspirin can work as an effective prevention tool in patients with coronary artery disease, aspirin use in such patients is low.

"With all of the investment this country makes developing new medications to treat disease, it is very important to utilize effectively the medications we already have," says Randall Stafford, MD, PhD, of the MGH Institute for Health Policy and General Medicine Division, the study's author.

Coronary artery disease — also commonly referred to as coronary heart disease — is the single largest killer of both men and women in the United States. An estimated 1.1 million Americans will suffer heart attacks this year, and more than 40 percent of them will die. In someone with the disease, blood vessels in the heart become narrowed causing such problems as angina, heart attacks and sudden death. Among patients known to have coronary artery disease, the use of aspirin cuts the risk of future problems by one-third by interfering with the formation of blood clots.

Stafford's study, which appeared in the March 14 issue of Circulation: Journal of the American Heart Association, looked at physician-reported rates of aspirin use in patients with coronary artery disease. Analysis of 10,942 office visits of patients with the disease found that although reported aspirin use had increased from 5 percent of patients in 1980 to 26 percent in 1996, only about one-quarter of patients reported taking aspirin in 1996.

The study also showed that aspirin use was less likely to be reported in patients over the age of 80, and that more men than women reportedly took aspirin. Cardiologists were slightly more likely than primary care physicians to recommend aspirin to patients.

Although Stafford acknowledges that physicians and their patients may fail to report aspirin use and that some patients should not take aspirin, he adds: "Even if aspirin use were double what we report, this would still represent suboptimal use of this life-saving medication. A substantial number of patients are at higher-than-necessary risk of developing future heart problems because they are not taking aspirin."

This study was supported by the National Heart, Lung and Blood Institute.