Mahon J, Steel K, Feagan B G, Laupacis A, Pederson L L
Department of Medicine, University of Western Ontario, London.
CMAJ. 1991 Nov 1;145(9):1107-16.
To determine physicians' attitudes toward prescribing acetylsalicylic acid (ASA), physicians' own use of ASA and the prevalence of ASA use in the community following the trials of ASA for primary prevention of coronary heart disease.
Random sample surveys of physicians and the general public by mail and telephone respectively and a mail survey of a selected panel of expert cardiologists and neurologists.
London, Ont., and surrounding Middlesex County.
A total of 210 physicians (77% of eligible subjects), including family practitioners and most types of specialists, with an active medical licence and 666 English-speaking people (75% of eligible subjects) aged 18 years or more living in a household with active, listed telephone service.
Long-term ASA use (at least 80 mg on alternate days for 4 or more consecutive weeks) for the treatment of atherosclerosis.
Sampled physicians and experts agreed that long-term ASA therapy was indicated in patients with unstable angina, a transient ischemic episode or recent myocardial infarction but not for primary prevention in healthy middle-aged men and women at low risk for ischemic vascular disease. Both groups were uncertain about the role of ASA in primary prevention in asymptomatic people with risk factors for atherosclerosis. Nine (16%) of the 55 male physicians aged 50 years or more took ASA routinely for primary prevention. In the community survey almost all those who used ASA routinely were 50 years or older. The proportions of men and women in this age group who used ASA routinely for any reason were 19% (95% confidence limits [CLs] 11 and 28) and 14% (95% CLs 8 and 19) respectively; the proportions of men and women who used ASA routinely and apparently for primary prevention were 8% and 1% respectively. A total of 43% (95% CLs 30 and 57) of those with apparent ischemic vascular disease took ASA routinely. Medically unsupervised long-term ASA use for primary or secondary prevention of ischemic vascular disease was uncommon (reported by 2% of those who used the drug routinely).
Physicians generally agree on a role for long-term ASA therapy in the secondary prevention of ischemic vascular disease. However, the prevalence of long-term ASA use in people with overt atherosclerosis in the community may be less than optimal. The role of the drug in the primary prevention of ischemic vascular disease is less accepted. Long-term ASA use in the community for primary prevention is uncommon but detectable.
在阿司匹林用于冠心病一级预防的试验之后，确定医生对开具阿司匹林（ASA）处方的态度、医生自身使用ASA的情况以及社区中ASA的使用 prevalence。
分别通过邮件和电话对医生及普通公众进行随机抽样调查，并对选定的心脏病专家和神经科专家小组进行邮件调查。
安大略省伦敦市及周边的米德尔塞克斯县。
共有210名医生（占符合条件受试者的77%），包括家庭医生和大多数专科医生类型，持有有效行医执照，以及666名18岁及以上、居住在有活跃、登记电话服务家庭中的讲英语的人（占符合条件受试者的75%）。
长期使用ASA（至少每隔一天服用80毫克，连续4周或更长时间）用于治疗动脉粥样硬化。
抽样的医生和专家一致认为，不稳定型心绞痛、短暂性缺血发作或近期心肌梗死患者需要长期ASA治疗，但对于缺血性血管疾病低风险的健康中年男性和女性，不建议用于一级预防。两组对于ASA在有动脉粥样硬化风险因素的无症状人群一级预防中的作用都不确定。55名50岁及以上的男性医生中有9名（16%）常规服用ASA进行一级预防。在社区调查中，几乎所有常规使用ASA的人都在50岁及以上。该年龄组因任何原因常规使用ASA的男性和女性比例分别为19%（95%置信区间[CLs]为11和28）和14%（95%CLs为8和19）；常规且明显用于一级预防的男性和女性比例分别为8%和1%。共有43%（95%CLs为30和57）明显患有缺血性血管疾病的人常规服用ASA。在没有医学监督的情况下，长期使用ASA进行缺血性血管疾病的一级或二级预防并不常见（常规使用该药物的人中2%报告有此情况）。
医生普遍认同长期ASA治疗在缺血性血管疾病二级预防中的作用。然而，社区中明显患有动脉粥样硬化的人群长期使用ASA的 prevalence 可能低于最佳水平。该药物在缺血性血管疾病一级预防中的作用较难被接受。在社区中用于一级预防的长期ASA使用并不常见，但可以检测到。
