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Issue 99 Item 15 Many Patients with Coronary Artery Disease Fail to Use Aspirin

Twenty percent of people with coronary artery disease still do not use aspirin therapy. Despite substantial evidence that aspirin saves lives and reduces the risk of heart attacks, a study conducted by Duke University Medical Center researchers indicated that, as of 1999, one in five people with coronary artery disease still did not take aspirin regularly.

In the study, published in the March 15, 2002, issue of the American Journal of Cardiology, 80.5 percent of patients questioned used aspirin in 1999. The 25,049 patients involved in the study, who were pulled from the Duke Databank for Cardiovascular Disease and had coronary artery disease diagnosed by angiography at Duke, were questioned on their aspirin use between 1995 and 1999.

While the 80.5 percent figure was a substantial increase from the 59.2 percent of patients using aspirin in 1995, Robert Califf, M.D, the study’s lead author, said the percentage seen in the 1999 data was "disappointingly low" considering the wealth of information supporting aspirin’s benefits in addition to it being inexpensive and available without prescription.

"Given the strong evidence for the benefit of aspirin combined with its low cost, the failure to achieve greater than 95 percent use of aspirin, or other antithrombotic therapy in this population, is disappointing. Adherence should have been greater," said Califf, who is director of the Duke Clinical Research Institute. He and his colleagues plan further studies to continue to follow the trend in aspirin use after 1999, the latest year for which data were available.

The study also showed that coronary artery disease patients who never used aspirin had nearly twice the risk of death (risk ratio of 1.85) than those patients who used aspirin, Califf noted.

Those patients who were less likely to be using aspirin therapy included those with heart failure, diabetes and hypertension.

"Too many patients without contraindications to aspirin fail to take it regularly. The health care system currently lacks effective methods to ensure that patients who have coronary artery disease have adequate follow-up concerning aspirin use," Califf said.

A small proportion of people should avoid aspirin use, Califf said(strikethrough: .) These include people with allergies to aspirin and with a history of significant gastrointestinal bleeding or gastrointestinal pain.

As recently as January 2002, the U.S. Preventative Services Task Force, part of the Public Health Service, strongly recommended that doctors discuss aspirin therapy with their patients, especially those at risk of coronary artery disease. These patients include men over the age of 40, postmenopausal women and younger people with risk factors for heart disease (smoking, diabetes, hypertension).

Every year, more than 1 million Americans die from heart attacks and other forms of coronary artery disease. American Journal of Cardiology March 15, 2002