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Journal of Community Health

, Volume 44, Issue 3, pp 561–568 | Cite as

Aspirin Use for Cardiovascular Disease Prevention in an African American Population: Prevalence and Associations with Health Behavior Beliefs

  • Jeremy R. Van’t HofEmail author
  • Sue Duval
  • Jeffrey R. Misialek
  • Niki C. Oldenburg
  • Clarence Jones
  • Milton Eder
  • Russell V. Luepker
Original Paper

Abstract

Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in the United States, disproportionately affecting African Americans. Aspirin is an effective, low cost option to reduce cardiovascular events. This study sought to describe the use of aspirin for CVD prevention in African Americans and evaluate associations with demographics, cardiovascular risk factors and health behaviors and beliefs. A total of 684 African Americans adults ages 45–79 years completed surveys and were included in this analysis. Proportions of aspirin use were stratified by primary and secondary prevention and by number of CVD risk factors in the primary prevention population. Logistic regression was used to evaluate associations with aspirin use. Secondary prevention aspirin use was 62%. Primary prevention aspirin use was 32% overall and increased to 54% in those with > 2 CVD risk factors. A history of diabetes [adjusted odds ratio (aOR) 3.42, 95% CI 2.18–5.35] and hypertension (aOR 2.25, 95% CI 1.39–3.65) were strongly associated with primary prevention aspirin use, but a conversation with a health care provider was even stronger (aOR 6.41, 95% CI 4.07–10.08). Participants who answered positively to statements about people similar to them taking aspirin or that close contacts think they should take aspirin, were much more likely to take aspirin (aOR 4.80; 95% CI 2.58–8.93 and aOR 7.45; 95% CI 4.70–11.79 respectively). These findings support a hypothesis that aspirin use may increase by encouraging conversations with health care providers and creating a supportive social environment for aspirin use. Further studies need to be done to test this hypothesis.

Keywords

Aspirin Prevention Cardiovascular disease African Americans Health behavior 

Notes

Funding

This study was funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, Grant No. R01HL126041.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

10900_2019_646_MOESM1_ESM.docx (13 kb)
Supplementary material 1 (DOCX 12 KB)

References

  1. 1.
    Benjamin, E. J., Virani, S. S., Callaway, C. W., Chamberlain, A. M., Chang, A. R., Cheng, S., et al. (2018). Heart disease and stroke statistics-2018 update: A report from the American Heart Association. Circulation, 137(12), e67–e492.CrossRefPubMedGoogle Scholar
  2. 2.
    Mensah, G. A., Mokdad, A. H., Ford, E. S., Greenlund, K. J., & Croft, J. B. (2005). State of disparities in cardiovascular health in the United States. Circulation, 111(10), 1233–1241.CrossRefPubMedGoogle Scholar
  3. 3.
    Sidney, S., Quesenberry, C. P., Jaffe, M. G., Sorel, M., Nguyen-Huynh, M. N., Kushi, L. H., et al. (2016). Recent trends in cardiovascular mortality in the United States and public health goals. JAMA Cardiology, 1(5), 594–599.CrossRefPubMedGoogle Scholar
  4. 4.
    Baigent, C., Blackwell, L., Collins, R., Emberson, J., Godwin, J., Peto, R., et al. (2009). Aspirin in the primary and secondary prevention of vascular disease: Collaborative meta-analysis of individual participant data from randomised trials. Lancet, 373(9678), 1849–1860.CrossRefPubMedGoogle Scholar
  5. 5.
    Rothwell, P. M., Algra, A., Chen, Z., Diener, H. C., Norrving, B., & Mehta, Z. (2016). Effects of aspirin on risk and severity of early recurrent stroke after transient ischaemic attack and ischaemic stroke: Time-course analysis of randomised trials. Lancet, 388(10042), 365–375.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Luepker, R. V., Steffen, L. M., Duval, S., Zantek, N. D., Zhou, X., & Hirsch, A. T. (2015). Population trends in aspirin use for cardiovascular disease prevention 1980–2009: The Minnesota Heart Survey. Journal of the American Heart Association, 4(12), e002320.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Steering Committee of the Physicians’ Health Study Research Group*. (1989). Final report on the aspirin component of the ongoing Physicians’ Health Study. New England Journal of Medicine, 321(3), 129–135.CrossRefGoogle Scholar
  8. 8.
    Hansson, L., Zanchetti, A., Carruthers, S. G., Dahlöf, B., Elmfeldt, D., Julius, S., et al. (1998). Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: Principal results of the Hypertension Optimal Treatment (HOT) randomised trial. Lancet, 351(9118), 1755–1762.CrossRefPubMedGoogle Scholar
  9. 9.
    Medical Research Council’s General Practice Research Framework. (1998). Thrombosis prevention trial: randomised trial of low-intensity oral anticoagulation with warfarin and low-dose aspirin in the primary prevention of ischaemic heart disease in men at increased risk. Lancet, 351(9098), 233–241.CrossRefGoogle Scholar
  10. 10.
    Ridker, P. M., Cook, N. R., Lee, I. M., Gordon, D., Gaziano, J. M., Manson, J. E., et al. (2005). A randomized trial of low-dose aspirin in the primary prevention of cardiovascular disease in women. New England Journal of Medicine, 352(13), 1293–1304.CrossRefPubMedGoogle Scholar
  11. 11.
    Ikeda, Y., Shimada, K., Teramoto, T., Uchiyama, S., Yamazaki, T., Oikawa, S., et al. (2014). Low-dose aspirin for primary prevention of cardiovascular events in Japanese patients 60 years or older with atherosclerotic risk factors: A randomized clinical trial. JAMA, 312(23), 2510–2520.CrossRefPubMedGoogle Scholar
  12. 12.
    ASCEND Study Collaborative Group. (2018). Effects of aspirin for primary prevention in persons with diabetes mellitus. New England Journal of Medicine, 379(16), 1529–1539.CrossRefGoogle Scholar
  13. 13.
    Gaziano, J. M., Brotons, C., Coppolecchia, R., Cricelli, C., Darius, H., Gorelick, P. B., et al. (2018). Use of aspirin to reduce risk of initial vascular events in patients at moderate risk of cardiovascular disease (ARRIVE): A randomised, double-blind, placebo-controlled trial. Lancet, 392(10152), 1036–1046.CrossRefPubMedGoogle Scholar
  14. 14.
    Calonge, N., Petitti, D. B., DeWitt, T. G., Gordis, L., Gregory, K. D., Harris, R., et al. (2009). Aspirin for the prevention of cardiovascular disease: US Preventive Services Task Force recommendation statement. Annals of Internal Medicine, 150(6), 396–404.CrossRefGoogle Scholar
  15. 15.
    Van’t Hof, J. R., Duval, S., Walts, A., Kopecky, S. L., Luepker, R. V., & Hirsch, A. T. (2017). Contemporary primary prevention aspirin use by cardiovascular disease risk: Impact of US Preventive Services Task Force Recommendations, 2007–2015: A Serial, Cross-sectional Study. Journal of the American Heart Association, 6(10), e006328.Google Scholar
  16. 16.
    Shahar, E., Folsom, A. R., Romm, F. J., Bisgard, K. M., Metcalf, P. A., Crum, L., et al. (1996). Patterns of aspirin use in middle-aged adults: The Atherosclerosis Risk in Communities (ARIC) Study. American Heart Journal, 131(5), 915–922.CrossRefPubMedGoogle Scholar
  17. 17.
    Rodondi, N., Vittinghoff, E., Cornuz, J., Butler, J., Ding, J., Satterfield, S., et al. (2005). Aspirin use for the primary prevention of coronary heart disease in older adults. The American Journal of Medicine, 118(11), 1281–1288.CrossRefGoogle Scholar
  18. 18.
    Glasser, S. P., Cushman, M., Prineas, R., Kleindorfer, D., Prince, V., You, Z., et al. (2008). Does differential prophylactic aspirin use contribute to racial and geographic disparities in stroke and coronary heart disease (CHD)? Preventive Medicine, 47(2), 161–166.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Sanchez, D. R., Roux, A. V. D., Michos, E. D., Blumenthal, R. S., Schreiner, P. J., Burke, G. L., & Watson, K. (2011). Comparison of the racial/ethnic prevalence of regular aspirin use for the primary prevention of coronary heart disease from the multi-ethnic study of atherosclerosis. The American Journal of Cardiology, 107(1), 41–46.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Johansen, M. E., Hefner, J. L., & Foraker, R. E. (2015). Antiplatelet and statin use in US patients with coronary artery disease categorized by race/ethnicity and gender, 2003 to 2012. The American Journal of Cardiology, 115(11), 1507–1512.CrossRefPubMedGoogle Scholar
  21. 21.
    Fang, J., George, M. G., Gindi, R. M., Hong, Y., Yang, Q., Ayala, C., et al. (2015). Use of low-dose aspirin as secondary prevention of atherosclerotic cardiovascular disease in US adults (from the National Health Interview Survey, 2012). The American Journal of Cardiology, 115(7), 895–900.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Winter, S. J., Sheats, J. L., & King, A. C. (2016). The use of behavior change techniques and theory in technologies for cardiovascular disease prevention and treatment in adults: A comprehensive review. Progress in Cardiovascular Diseases, 58(6), 605–612.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Plotnikoff, R. C., Lubans, D. R., Costigan, S. A., & McCargar, L. (2013). A test of the theory of planned behavior to predict physical activity in an overweight/obese population sample of adolescents from Alberta, Canada. Health Education & Behavior, 40(4), 415–425.CrossRefGoogle Scholar
  24. 24.
    Norman, P., Conner, M., & Bell, R. (1999). The theory of planned behavior and smoking cessation. Health Psychology, 18(1), 89–94.CrossRefPubMedGoogle Scholar
  25. 25.
    Lin, C. Y., Broström, A., Nilsen, P., & Pakpour, A. H. (2018). Using extended theory of planned behavior to understand aspirin adherence in pregnant women. Pregnancy Hypertension, 12, 84–89.CrossRefPubMedGoogle Scholar
  26. 26.
    Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50(2), 179–211.CrossRefGoogle Scholar
  27. 27.
    Brown, D. W., Shepard, D., Giles, W. H., Greenlund, K. J., & Croft, J. B. (2005). Racial differences in the use of aspirin: An important tool for preventing heart disease and stroke. Ethnicity & Disease, 15(4), 620–626.Google Scholar
  28. 28.
    Gu, Q., Dillon, C. F., Eberhardt, M. S., Wright, J. D., & Burt, V. L. (2015). Preventive aspirin and other antiplatelet medication use among US adults aged ≥ 40 years: Data from the National Health and Nutrition Examination Survey, 2011–2012. Public Health Reports, 130(6), 643–654.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Karmali, K. N., Goff, D. C., Ning, H., & Lloyd-Jones, D. M. (2014). A systematic examination of the 2013 ACC/AHA pooled cohort risk assessment tool for atherosclerotic cardiovascular disease. Journal of the American College of Cardiology, 64(10), 959–968.CrossRefPubMedGoogle Scholar
  30. 30.
    Williams, C. D., Chan, A. T., Elman, M. R., Kristensen, A. H., Miser, W. F., Pignone, M. P., et al. (2015). Aspirin use among adults in the US: Results of a national survey. American Journal of Preventive Medicine, 48(5), 501–508.CrossRefPubMedGoogle Scholar
  31. 31.
    Halbert, C. H., Armstrong, K., Gandy, O. H., & Shaker, L. (2006). Racial differences in trust in health care providers. Archives of Internal Medicine, 166(8), 896–901.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Victor, R. G., Lynch, K., Li, N., Blyler, C., Muhammad, E., Handler, J., et al. (2018). A cluster-randomized trial of blood-pressure reduction in black barbershops. New England Journal of Medicine, 378(14), 1291–1301.CrossRefPubMedGoogle Scholar
  33. 33.
    Zantek, N. D., Luepker, R. V., Duval, S., Miller, K., Oldenburg, N., & Hirsch, A. T. (2014). Confirmation of reported aspirin use in community studies: Utility of serum thromboxane B2 measurement. Clinical and Applied Thrombosis/Hemostasis, 20(4), 385–392.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Cardiovascular DivisionUniversity of Minnesota Medical SchoolMinneapolisUSA
  2. 2.Division of Epidemiology and Community Health, School of Public HealthUniversity of MinnesotaMinneapolisUSA
  3. 3.Hue-Man PartnershipMinneapolisUSA
  4. 4.Department of Family Medicine and Community HealthUniversity of Minnesota Medical SchoolMinneapolisUSA

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