Elsevier

The American Journal of Medicine

Volume 118, Issue 11, November 2005, Pages 1288.e1-1288.e9
The American Journal of Medicine

Clinical research study
Aspirin use for the primary prevention of coronary heart disease in older adults

https://doi.org/10.1016/j.amjmed.2005.06.020Get rights and content

Abstract

Purpose

Aspirin for the primary prevention of coronary heart disease (has a more favorable risk/benefit profile among adults with high coronary heart disease risk than among low-risk adults, but there is little information on the current patterns of aspirin use for primary prevention. We determined the prevalence of aspirin use in relation to coronary heart disease risk and changes over time.

Subjects and methods

We measured regular aspirin use in 2163 black and white older adults without cardiovascular disease in a population-based cohort from 1997 to 1998 and 2002 to 2003. We determined the 10-year coronary heart disease risk by using the Framingham risk score.

Results

In 1997-1998, 17% of the cohort were regular aspirin users. Aspirin use increased with coronary heart disease risk from 13% in persons with a 10-year risk less than 6% (low risk) to 23% in those with a 10-year risk greater than 20% (highest risk) (P for trend < .001). Blacks were less likely to use aspirin (13%) than whites (20%). In multivariate analysis, black race was still associated with lower aspirin use (odds ratio 0.66, 95% confidence interval 0.49-0.89). In 1997-1998 and 2002 to 2003, aspirin use increased from 17% to 32% among those still free of coronary heart disease (P < .001), and the association with coronary heart disease risk continued (P for trend < .001). Despite their high coronary heart disease risk, diabetic persons were not more likely to use aspirin than nondiabetic persons, even in 2002 and 2003 (odds ratio 0.89, 95% confidence interval 0.56-1.40).

Conclusion

Regular use of aspirin by older adults with no history of cardiovascular disease has increased in recent years. Individuals at higher coronary heart disease risk are more likely to take aspirin, but there is room for considerable improvement in targeting those at high risk, particularly diabetic persons and blacks.

Section snippets

Subjects and design

This prospective study examined participants in the Health, Aging, and Body Composition Study (Health ABC), a population-based study of 3075 healthy community-dwelling men and women aged 68 to 80 years. Participants were identified from a random sample of white and all black Medicare-eligible adults living in designated zip codes areas surrounding Pittsburgh, Pa, and Memphis, Tenn; details of the eligibility criteria have been described.13 All participants gave written informed consent; the

Baseline characteristics

Fifty-five percent of the participants were women, and 42% were black (Table 1). In 1997 and 1998, 367 participants (17%) were regular aspirin users.

Coronary heart disease risk

Aspirin use increased with 10-year coronary heart disease risk by Framingham risk score from 13% in persons with a 10-year risk less than 6% (low risk) to 23% in those with a 10-year risk greater than 20% (highest risk) (P for trend < .001).

Other covariates

Aspirin use was less frequent in black participants (13%) compared with white participants (20%). Aspirin use

Discussion

This population-based study of a biracial cohort of older adults suggests that aspirin use for primary prevention has increased in recent years, to one third of the older population. Individuals at higher coronary heart disease risk were more likely to take aspirin. However, aspirin was not sufficiently targeted to high-risk individuals, particularly diabetic persons and blacks. In 2002 and 2003, only 37% of adults with a 10-year coronary heart disease risk greater than 20% used aspirin; 24% of

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    This study was supported by Contracts NO1-AG-6-2101, NO1-AG-6-2103, and NO1-AG-6-2106 of National Institute on Aging. The National Institute on Aging funded the Health ABC study, reviewed the article, and approved its publication. Dr. Rodondi was supported by a grant from the Swiss National Foundation (PBLAB-102353).

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