Aspirin Use and Counseling About Aspirin Among Patients With Diabetes
- Sarah L. Krein, PHD, RN123,
- Sandeep Vijan, MD, MS123,
- Leonard M. Pogach, MD, MBA45,
- Mary M. Hogan, PHD, RN1 and
- Eve A. Kerr, MD, MPH12
- 1Department of Veterans Affairs’ Center for Practice Management and Outcomes Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- 2Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
- 3Michigan Diabetes Research and Training Center, Ann Arbor, Michigan
- 4VA New Jersey Healthcare System, East Orange, New Jersey
- 5University of Medicine and Dentistry of New Jersey, Newark, New Jersey
OBJECTIVE—Despite being a safe, effective therapy for lowering cardiovascular risk, only 20% of diabetic patients were using aspirin in the early 1990s. This study examines current physician practices and the use of aspirin therapy by individuals with diabetes.
RESEARCH DESIGN AND METHODS—A random sample of diabetic patients receiving care in the Department of Veterans Affairs health care system were surveyed during January-March 2000. The association between aspirin counseling, aspirin use, and reported coronary vascular disease (CVD) and classical CVD risk factors were examined using logistic regression. The effect of increasing aspirin use on risk of myocardial infarction (MI) and cardiovascular mortality was demonstrated by simulation.
RESULTS—Seventy-one percent of respondents reported being counseled about aspirin use, and 66% were taking daily aspirin. Individuals with known CVD were more likely to be counseled (odds ratio [OR] 4.9, 95% CI 2.9–8.1) and to use aspirin (2.1, 1.2–3.7). The factor most strongly associated with aspirin use was having been counseled about aspirin therapy by a doctor. We estimate that for this population, increasing daily aspirin use to 90% could prevent an additional 11,000 MIs and potentially save >8,000 lives.
CONCLUSIONS—Compared with previous reports, a substantial proportion of these diabetic patients have been counseled about and use aspirin. Most clinicians recognize aspirin as an important treatment for patients with preexisting coronary disease. However, since diabetes is now considered a CVD equivalent, it is imperative that clinicians include counseling about aspirin therapy as a care priority for all their diabetic patients, as this simple intervention may prevent many cardiovascular events and deaths.
- CVD, coronary vascular disease
- DQIP, Diabetes Quality Improvement Project
- MI, myocardial infarction
- OR, odds ratio
- VA, Veterans Affairs
- VISN, veterans integrated service network
Address correspondence and reprint requests to Sarah L. Krein, Ann Arbor VA HSR&D, P.O. Box 130170, Ann Arbor, MI 48113. Hand-delivered mail must be sent to 24 Frank Lloyd Wright Dr., 3rd floor, Lobby L, Ann Arbor, MI 48106. E-mail:.
Received for publication 14 November 2001 and accepted in revised form 21 February 2002.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
- DIABETES CARE