Gender differences in aspirin use among adults with coronary heart disease in the United States.
BACKGROUND
Aspirin reduces mortality for men and women with coronary heart disease (CHD). Previous research suggests women with acute coronary syndromes receive less aggressive care, including less frequent early administration of aspirin. The presence of gender differences in aspirin use for secondary prevention is less clear.


OBJECTIVE
To determine if a gender difference exists in the use of aspirin for secondary prevention among individuals with CHD.


METHODS
We analyzed data from the nationally representative 2000-2002 Medical Expenditure Panel Surveys to determine the prevalence of regular aspirin use among men and women with CHD.


METHODS
Participants, 1,869, 40 years and older who reported CHD or prior myocardial infarction.


RESULTS
Women were less likely than men to use aspirin regularly (62.4% vs 75.6%, p < .001) even after adjusting for demographic, socioeconomic and clinical characteristics (adjusted OR = 0.62, 95% CI, 0.48-0.79). This difference narrowed but remained significant when the analysis was limited to those without self-reported contraindications to aspirin (79.8% vs 86.4%, P = .002, adjusted OR = 0.68, 95% CI, 0.48-0.97). Women were more likely than men to report contraindications (20.5% vs 12.5%, P < .001). Differences in aspirin use were greater between women and men with private health insurance (61.8% vs 79.0%, P < .001, adjusted OR = 0.48, 95% CI, 0.35-0.67) than among those with public coverage (62.5% vs 70.7%, P = .04, adjusted OR = 0.74, 95% CI, 0.50-1.11) (P < .001 for gender-insurance interaction).


CONCLUSIONS
We found a gender difference in aspirin use among patients with CHD not fully explained by differences in patient characteristics or reported contraindications. These findings suggest a need for improved secondary prevention of cardiovascular events for women with CHD.
Opotowsky
Alexander R
AR
Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA. alexander.opotowsky@uphs.upenn.edu
McWilliams
J Michael
JM
Cannon
Christopher P
CP
D000367:Age Factors; D000368:Aged; D001241:Aspirin / Q000627:therapeutic use*; D003327:Coronary Disease / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D015438:Health Behavior; D019538:Health Care Surveys; D006801:Humans; D007348:Insurance, Health; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology / Q000517:prevention & control*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D044469:Racial Groups; D012737:Sex Factors; D014481:United States / Q000453:epidemiology
D010975:Platelet Aggregation Inhibitors; D001241:Aspirin