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).

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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.

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 “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.