Randall Stafford and colleagues at Stanford University School of Medicine found that in 2003, only about a third of "high risk patients" were prescribed the drug. High risk patients are those who already have cardiovascular disease and are at high risk of further "cardiovascular events," such as heart attacks and strokes.
Based on the results of many previous studies, experts worldwide recommend aspirin for all high risk patients except when the risk of side effects would outweigh the benefits (for example, if there is too much of a risk that the drug could cause internal bleeding). The new study therefore suggests that aspirin is being under-prescribed.
People with diabetes are also at higher risk of cardiovascular disease, and the American Diabetes Association recommends aspirin to all people with diabetes over the age of 40. Yet Dr Stafford and colleagues found that in 2003 only 12% of people with diabetes were receiving the drug.
In their study, patients receiving aspirin were more likely to be male, and cared for by cardiologists (rather than general physicians or other specialists) and by hospital outpatient departments (rather than private practices).
The researchers based their study on data from two national surveys, and they compared physicians' prescribing practices from 1993 to 2003. Beginning in 1997-1998, they found that physicians prioritized statins over aspirin for reducing patients' risk of cardiovascular events, even though aspirin is the cheaper and more cost effective drug.
"Statins are newer and more intensely advertised than aspirin," say the researchers, "which may partly explain the preferential use of these drugs."
The researchers expressed concern that physicians are failing to use the full range of strategies available to reduce patients' risk of heart disease and stroke.
Citation: Stafford RS, Monti V, Ma J (2005) Underutilization of aspirin persists in US ambulatory care for the secondary and primary prevention of cardiovascular disease. PLoS Med 2(12): e353.
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