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Gender Differences in Aspirin use Among Adults With Coronary Heart Disease in the United States

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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.

Design

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.

Participants

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).

Conclusion

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.

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Acknowledgement

This work was supported (J.M.M.) by a fellowship from the Agency for Healthcare Research and Quality, Department of Health and Human Services (T32 HS00020-20).

Potential Financial Conflicts of Interest

None disclosed.

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Authors and Affiliations

  1. Department of Medicine, Brigham and Women’s Hospital, Boston, MA, 02115, USA

    Alexander R. Opotowsky MD, MPH, J. Michael McWilliams MD & Christopher P. Cannon MD

  2. TIMI Study Group, Boston, MA, 02115, USA

    Christopher P. Cannon MD

  3. Department of Medicine, Cardiovascular Medicine Division, University of Pennsylvania Medical Center, 9 Founders Pavilion, 3400 Spruce Street, Philadelphia, PA, 19104, USA

    Alexander R. Opotowsky MD, MPH

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  1. Alexander R. Opotowsky MD, MPH
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Correspondence to Alexander R. Opotowsky MD, MPH.

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Opotowsky, A.R., McWilliams, J.M. & Cannon, C.P. Gender Differences in Aspirin use Among Adults With Coronary Heart Disease in the United States. J GEN INTERN MED 22, 55–61 (2007). https://doi.org/10.1007/s11606-007-0116-5

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