C-B4-04: Underuse of Aspirin in Women for Primary and Secondary Prevention of Cardiovascular Disease Events

Abstract

Background and Aims: Cardiovascular disease (CVD) is the leading cause of death among women. Consistent with studies documenting that aspirin (ASA) use decreases the risk of CVD events in certain groups, the American Heart Association (AHA) published specific evidence based guidelines for ASA use in women. This paper evaluates the self-reported use of ASA among women and examined characteristics of those most likely to be adhering to clinical guidelines. Methods: Data from 127 healthcare centers across the U.S. using a commercial, web-based CVD risk assessment tool (HeartAware™) were analyzed. Volunteer respondents answered questions about their CVD risk factors, the presence or absence of coronary, cerebral, peripheral arterial disease, diabetes, and medication use including daily ASA. Individuals who, based on the AHA 2007 guidelines should be taking ASA (for primary and secondary prevention) were included in the analysis. Univariate and multivariate logistic regression analyses were performed to identify factors significantly associated with ASA intake. Results: Of the 21,199 women who should be on ASA based on guideline information, only 42% reported the use for primary prevention and 68% for secondary prevention. Multivariate regression analysis found that African Americans (OR = 0.61, 95% CI 0.53–0.70, p<0.0001) and Hispanics (OR = 0.67, 95% CI 0.53–0.83, p=0.0004) were less likely than Caucasians to be taking ASA. Other factors that contributed significantly (p<0.001) to ASA use were a relationship with a PCP or cardiologist, taking blood pressure medications, past history of smoking, a family history of heart disease, and a family history of high cholesterol. Conclusions: Findings from a large cross-sectional cohort revealed that 58% of women who should be taking ASA for primary prevention and 32% of women who should be taking ASA for secondary prevention of CVD events were not following national guidelines. Individuals from racial/ethnic minorities were less likely to be taking ASA compared with Caucasians suggesting targets for intervention. These findings emphasize the need for ASA education among clinicians to provide guidance for targeting educational efforts that can improve CVD outcomes in women.