Lower use of low-dose aspirin for the primary prevention of cardiovascular disease (CVD) in blacks vs whites may partly account for racial discrepancies in the incidence of ischemic cardiac death, according to a study published in the Journal of the American Heart Association.
In this study, non-Hispanic black and white adults (n=65,231) between the ages of 40 and 79 years, with no history of CVD, and residing in the Southeastern United States were enrolled between 2002 and 2009. The simplified Framingham 10-year CVD risk was calculated, and participants were categorized as being at low (n=8231), intermediate (n=12,409), or high risk (n=44,591) of developing CVD.
Black participants were found to be less likely to use low-dose aspirin for the prevention of CVD compared with white participants, regardless of CDD risk (adjusted odds ratio [aOR], 0.79; 95% CI, 0.75-0.82). The use of low-dose aspirin was associated with a trend toward reduced ischemic cardiac death risk in white participants (median follow-up, 11.3 years; adjusted hazard ratio [aHR], 0.86; 95% CI, 0.68-1.10), particularly in women (aHR, 0.72; 95% CI, 0.51-1.02), but not in black participants (aHR, 1.18; 95% CI, 0.98-1.40).
There were similar trends between the use of low-dose aspirin and reduced risk for ischemic cardiac death in high-risk participants between the ages of 50 and 69 years (whites: aHR, 0.78; 95% CI, 0.57-1.08 vs blacks: aHR, 1.10; 95% CI, 0.88-1.39) and between the ages of 50 and 59 years (whites: aHR, 0.74; 95% CI, 0.49-1.12 vs blacks: aHR, 1.04; 95% CI, 0.77-1.41).
Study limitations include the lack of data on the duration of aspirin therapy and a reliance on self-reports, which may have introduced recall and misclassification bias.
“Cultural barriers, mistrust of the health care establishment, and disparities throughout the continuum of prevention and care, including access to and quality of health care, are plausible factors [underlying the disparities between racial and ethnic groups regarding the use of low-dose aspirin for CVD prevention],” noted the study authors.
Fernandez-Jimenez R, Wang TJ, Fuster V, Blot WJ. Low-dose aspirin for primary prevention of cardiovascular disease: use patterns and impact across race and ethnicity in the Southern Community Cohort Study. J Am Heart Assoc. 2019;8(24):e013404.