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Abstract
BackgroundLittle is known about the relationship between cardiovascular risk, disease and actual use of aspirin in the community.MethodsThe Measuring Disparities in Chronic Conditions (MDCC) study is a community and health facility-based survey designed to track disparities in the delivery of health interventions for common chronic diseases. MDCC includes a survey instrument designed to collect detailed information about aspirin use. In King County, WA between 2011 and 2012, we surveyed 4633 white, African American, or Hispanic adults (45% home address-based sample, 55% health facility sample). We examined self-reported counseling on, frequency of use and risks of aspirin for all respondents. For a subgroup free of CAD or cerebral infarction that underwent physical examination, we measured 10-year coronary heart disease risk and blood salicylate concentration.ResultsTwo in five respondents reported using aspirin routinely while one in five with a history of CAD or cerebral infarction and without contraindication did not report routine use of aspirin. Women with these conditions used less aspirin than men (65.0% vs. 76.5%) and reported more health problems that would make aspirin unsafe (29.4% vs. 21.2%). In a subgroup undergoing phlebotomy a third of respondents with low cardiovascular risk used aspirin routinely and only 4.6% of all aspirin users had no detectable salicylate in their blood.ConclusionsIn this large urban county where health care delivery should be of high quality, there is insufficient aspirin use among those with high cardiovascular risk or disease and routine aspirin use by many at low risk. Further efforts are needed to promote shared-decision making between patients and clinicians as well as inform the public about appropriate use of routine aspirin to reduce the burden of atherosclerotic vascular disease.
Highlights
Little is known about the relationship between cardiovascular risk, disease and actual use of aspirin in the community
We found that 42% of surveyed respondents used aspirin routinely (27.8% in the community sample and 51.7% in the health facility sample)
Our study was designed to address the limitations of random population sampling by identifying more respondents with elevated risk than is found in untargeted community surveys. Supporting this hypothesis, we found only 8.1% in the community sample had disease compared with 33.6% in the health facility sample
Summary
Little is known about the relationship between cardiovascular risk, disease and actual use of aspirin in the community. Aspirin is among the least expensive and most widely available of medications yet little is known about how it is being used. Efforts to reduce the burden of cardiovascular disease, the leading cause of death in the world, have focused on improving the use of aspirin for individuals at higher risk of atherosclerotic vascular disease [1,2]. Hearts initiative seeks to prevent one million heart attacks and strokes over 5 years, in part, by promoting appropriate aspirin therapy and other effective interventions. Data on aspirin use in the community is extremely limited and has generally focused on select populations of higher-risk individuals or national surveys [3,4,5]. No methods have been developed to track the appropriateness of this widely adopted intervention at the local level
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