Aspirine
wordt te weinig gebruikt.*
Uit
een Amerikaanse studie blijkt dat nog niet 1/3 van de mensen die een verhoogd
risico hebben op hart- en vaatziektes aspirine gebruiken maar vaak nog de dure
medicijnen zoals statine. Aspirine is een oud en veilig medicijn met dezelfde
werking ter voorkoming van hartziektes als die dure medicijnen. De dure
medicijnen worden zoveel voorgeschreven als gevolge van de zware
marketingcampagnes terwijl dagelijks 325 mg aspirine de kans op hartproblemen
ook met 40% kan reduceren.
Aspirin
advice ignored by those who need it
A
daily dose of aspirin is an inexpensive, proven strategy for reducing the
likelihood of heart disease among those most at risk for such disorders, yet a
new study from the Stanford University School of Medicine shows that aspirin
therapy is being used by fewer than one-third of the U.S. outpatients who would
benefit from it.
Instead,
the research found, many doctors are opting to prescribe the more expensive,
heavily marketed statin drugs, which are no more effective than aspirin in
preventing heart disease.
"What
really concerns us is the degree of aspirin underutilization among patients who
have already had a heart attack or a stroke because this is the group for which
there is conclusive clinical evidence that aspirin reduces the risk for
cardiovascular disease," said Jun Ma, MD, PhD, research associate at the
Stanford Prevention Research Center and senior author of the study that appears
in the November issue of the Public Library of Science-Medicine.
Of
those with the highest risk for cardiovascular disease, the study showed that
only 33 percent of their outpatient visits were associated with aspirin therapy
in 2003. That's an increase from the 1993 rate of 22 percent, but Ma said the
gain is minimal considering the abundant proof of aspirin's benefits for such
patients.
And
although aspirin use remains low, the study found that U.S. physicians are
increasingly prioritizing a class of drugs known as statins as the primary drug
strategy for preventing heart disease. Statins, while as effective as aspirin in
preventing heart attacks, cost substantially more. The researchers speculate
that the heavy marketing of statins in the United States is spurring patients
and doctors toward these newer - although not necessarily better - medications.
"Our
concern is that physicians are failing to use the full range of strategies
available to reduce patients' risk of heart disease and stroke," said
Randall Stafford, MD, PhD, associate professor of medicine at the Stanford
Prevention Research Center and the first author of the study.
Cardiovascular
disease remains the leading cause of death in the United States for both men and
women. The American Heart Association estimates that the various types of
cardiovascular disease, including heart attack and stroke, affect more than 70
million Americans.
Aspirin
therapy is one way for patients diagnosed with a significant risk for heart
disease to lower that risk. Aspirin reduces the clotting action of the blood's
platelets, thereby lowering the risk of heart attack, stroke and other diseases
that can occur when the blood vessels are blocked by clots. In several clinical
trials, daily doses of between 75 and 325 milligrams of aspirin cut the risk of
cardiovascular events by 15 to 40 percent. However, aspirin can cause
gastrointestinal bleeding in up to 4.5 percent of patients; physicians and
patients must weigh that risk against aspirin's benefits before deciding whether
to use it. For several years, clinical guidelines have recommended aspirin
therapy for patients with a significant risk of heart disease. Ma and Stafford
said their study is the first to examine how aspirin use varies among U.S.
outpatients according to their heart-disease risk.
The
researchers used two national databases that tracked outpatient visits to
hospitals and physician offices between 1993 and 2003, and then assessed the
reported use of aspirin therapy associated with those visits. Patients were
categorized according to their risk of cardiovascular disease. High-risk
patients were those who had been diagnosed with heart disease or had experienced
a heart attack or stroke. Intermediate-risk patients were divided into two
groups: one for those who had diabetes and additional risk factors for heart
disease (such as high blood pressure, high cholesterol and smoking); and the
other for non-diabetic adults with at least two risk factors for heart disease.
All other patients were placed in the low-risk category.
While
less than a third of the high-risk patient visits were associated with aspirin
therapy, the 2003 rates were even lower for those in the intermediate groups: 12
percent of the diabetic group and 16 percent for the non-diabetics.
Ma
and Stafford acknowledged that measuring aspirin usage is difficult because
doctors don't always document the over-the-counter medications their patients
take. However, based on previous studies that found low rates of aspirin use,
the researchers said they don't believe such under-reporting would account for
the huge gap between the clinical recommendations and what they found in the new
study.
One finding that intrigued the researchers is the growing popularity of statins, which help reduce the amount of LDL or "bad" cholesterol in the blood. Statins and aspirin have similar overall rates of effectiveness in reducing cardiovascular risk, but they vary significantly in cost. A daily dose of the most frequently prescribed statin medication costs around $2 while a daily dose of aspirin costs mere pennies (November 2005)
