Luepker Russell V, Oldenburg Niki C, Misialek Jeffrey R, Van't Hof Jeremy R, Finnegan John R, Eder Milton, Duval Sue
Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota; Cardiovascular Division & Lillehei Heart Institute, University of Minnesota Medical School, Minneapolis, Minnesota.
Cardiovascular Division & Lillehei Heart Institute, University of Minnesota Medical School, Minneapolis, Minnesota.
Am J Prev Med. 2021 Apr;60(4):513-519. doi: 10.1016/j.amepre.2020.10.025. Epub 2021 Feb 3.
Daily aspirin use for primary cardiovascular disease prevention is common among adults. Numerous clinical trials observe reduced cardiovascular disease with regular low-dose aspirin. The U.S. Preventive Services Task Force in 2016 published guidelines for aspirin use, but controversy exists about the side effects, and overuse or underuse may be common despite the guidelines. Using the Task Force recommendations, this paper describes the prevalence of appropriate aspirin use and physician advice in a population sample.
A random sample of men and women (aged 50-69 years) living in the Upper Midwest in 2017-2018 were surveyed, collecting demographic data, health history, and aspirin use. Appropriate primary prevention with aspirin was defined as having ≥10% cardiovascular disease risk (hypertension, hyperlipidemia, diabetes, smoking) with daily or every other day aspirin use. Those with prevalent cardiovascular disease were labeled as secondary prevention.
A total of 1,352 adults were surveyed (697 women, 655 men). The criteria for secondary prevention were fulfilled in 188 participants, and these were eliminated from the analysis. In the remaining group, aspirin was indicated in 32.9% (383 of 1,164). Among those, 46.0% (176 of 383) were appropriate users, and 54.0% (207 of 383) were nonusers despite indications. Overuse, where aspirin is not indicated, was common at 26.9% (210 of 781). Discussion with a physician, although reported in 29% of subjects, was associated with some improvement in the appropriate use but also with overuse and underuse.
Aspirin use for primary cardiovascular disease prevention is common. However, many adults are medicating without indication (overuse) or are not using aspirin despite guidelines (underuse).
成年人中每日服用阿司匹林进行原发性心血管疾病预防的情况很常见。众多临床试验观察到规律服用低剂量阿司匹林可降低心血管疾病风险。美国预防服务工作组在2016年发布了阿司匹林使用指南，但对于其副作用存在争议，尽管有指南，过度使用或使用不足的情况可能仍然普遍。本文依据该工作组的建议，描述了在一个人群样本中适当使用阿司匹林的患病率以及医生的建议情况。
对2017 - 2018年居住在中西部上游地区的年龄在50 - 69岁的男性和女性进行随机抽样调查，收集人口统计学数据、健康史和阿司匹林使用情况。阿司匹林的适当原发性预防被定义为患有≥10%心血管疾病风险（高血压、高脂血症、糖尿病、吸烟）且每日或隔日服用阿司匹林。患有心血管疾病的患者被标记为二级预防。
共对1352名成年人进行了调查（697名女性，655名男性）。188名参与者符合二级预防标准，这些人被排除在分析之外。在其余人群中，32.9%（1164人中的383人）需要使用阿司匹林。其中，46.0%（383人中的176人）是适当使用者，54.0%（383人中的207人）尽管有指征但未使用。在无使用指征情况下过度使用阿司匹林的情况很常见，占26.9%（781人中的210人）。与医生进行过讨论的患者占29%，虽然这与适当使用情况的一定改善相关，但也与过度使用和使用不足有关。
使用阿司匹林进行原发性心血管疾病预防很常见。然而，许多成年人在无指征的情况下用药（过度使用），或者尽管有指南却未使用阿司匹林（使用不足）。
