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Item
#15
Many Patients with Coronary Artery Disease Fail to Use Aspirin
Therapy
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
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Fact:
For every one-percentage point drop in the
Hemoglobin A1c diabetes complication rates drop by more than 25%.
Source: Diabetes 2001: Vital Stats.
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