Intended for healthcare professionals


Use of aspirin in secondary prevention of coronary heart disease is rising

BMJ 1996; 312 doi: (Published 30 March 1996) Cite this as: BMJ 1996;312:846
  1. A J Carney,
  2. T A Carney
  1. Medical student Addenbrooke's Hospital, Cambridge CB2 2QQ
  2. General practitioner Burn Brae Medical Group, Hexham, Northumberland NE46 2ED

    EDITOR,—We can confirm Ray King and Jonathan Denne's findings of an increased use of low dose aspirin in secondary prevention of cardiovascular disease1 and have a suggestion for why there may be a difference in the prevalence of such treatment between the sexes and how this might be overcome.

    Throughout 1994 and 1995 the Burn Brae Medical Group, a practice of six partners with 8200 patients in a market town, carried out three audits of the subject. A computer search followed by analysis of both computer and written notes identified 531 patients with cardiovascular disease (myocardial infarction 111, angina 304, transient ischaemic attack or cerebrovascular accident 92, and peripheral vascular disease 91; many patients had more than one vascular disease). Initially 255 patients were taking aspirin (men 148/280 (53%), women 107/251 (43%)). At the end of the second audit, after telephone contact or postal questionnaire and invitation to a specific consultation with their general practitioner, the number receiving low dose aspirin had increased to 342, with a significant difference between the sexes (197 (70%) men, 145 (58%) women; P<0.01). In July 1995 we therefore carried out a third audit of 100 patients from the original cohort. All were aged under 75 (50 men; 50 patients taking aspirin). The response to a telephone or postal questionnaire (85% response rate) showed no difference between the sexes in the advice offered by general practitioners, and heeded by patients, about stopping smoking, taking exercise, reducing dietary fat, and taking low dose aspirin. As would be expected, those not taking aspirin were less likely to have been given this advice (26/41 (66%) v 42/44 (95%) for both sexes). Women were more likely to complain that aspirin upset their stomach (7/43 (16%) v 3/42 (7%)).

    One of the most interesting findings was that, while the vast majority of patients (75) confirmed that television, radio, newspapers, and magazines were other sources of information about the benefits of stopping smoking, taking exercise, and reducing cholesterol, a considerable number (24) specifically commented that they had not seen similar information about low dose aspirin.

    We suggest that, although low dose aspirin is being increasingly prescribed, general practitioners should give specific advice to take aspirin to all high risk patients. Possibly women are less tolerant of low dose aspirin than men. Finally, national health educational bodies should target the media to increase society's knowledge of the benefits of low dose aspirin in the secondary prevention of cardiovascular disease.


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