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BACKGROUND: In 2009, The U.S. Preventive Services Task Force (USPSTF) recommended aspirin use for men aged 45 to 79 years when the potential benefit of a reduction in myocardial infarctions (MI) outweighs the potential harm of an increase in gastrointestinal hemorrhage. Previous studies have assessed population-level aspirin use for cardiovascular disease (CVD) prevention using the Behavioral Risk Factor Surveillance System (BRFSS), but none have specifically examined aspirin use within the groups highlighted in the USPSTF recommendation. We examine the prevalence of aspirin usage among men in North Carolina (NC) for whom aspirin therapy is potentially beneficial.
METHODS: The study population included 45 to 79 year-old male respondents without any contraindications to aspirin use on the 2011 NC BRFSS survey. Aspirin intake was ascertained by a “yes” response to the question: “do you take aspirin daily or every other day?” The Medical College of Wisconsin Coronary Heart Disease Risk Calculator online was used to estimate MI risk for hypothetical individuals with multiple combinations of age and risk factors from the study sample. The resulting risk estimates were compared the USPSTF recommendation statement to determine for whom the potential benefits of aspirin outweighed the risks. All analyses were performed using STATA version 13.0 and accounted for the complex sampling design by using sampling weights.
RESULTS: Among the 2,630 participants retained for this study, the weighted prevalence of reported aspirin use was 52.9% [95% confidence interval (CI): 49.4, 56.2]. The 45-54 years age group had the lowest prevalence of reported aspirin use (34.3% [28.4, 40.2]) while the 65-74 age group had the highest (74.2% [69.2, 79.3]). Compared to White non-Hispanics, Black non-Hispanics (Prevalence Ratio (PR):0.75; 95% CI [0.60, 0.94]) and Hispanics (0.50 [0.27, 0.92]) were significantly less likely to be on aspirin. Most participants (92.6% [90.3, 94.4]) had one or more of four risk factors-- hypertension, diabetes, high cholesterol and smoking—and the estimated possible MI risk indicates that aspirin therapy is potentially more beneficial than harmful.
CONCLUSIONS: In NC, aspirin is potentially more beneficial than harmful for primary prevention of MI for almost all men age 45 to 79 years who have no contraindications to aspirin use. However, aspirin use in this group is relatively low. Given the race/ethnicity and age disparities in reported aspirin use, promoting aspirin use through health systems interventions and community clinical linkages to these groups could increase overall aspirin use and reduce disparities in NC.