Aspirin use in middle-aged men with cardiovascular disease: are opportunities being missed?

BACKGROUND: Since the 1980s, clinical trial evidence has supported aspirin use in the secondary prevention of cardiovascular disease (CVD). AIM: To explore aspirin use among British men with known CVD in a population-based study. METHOD: Longitudinal study (British Regional Heart Study), in which subjects have been followed up for cardiovascular morbidity and mortality since 1978-1980. Aspirin use was assessed by questionnaires to study participants in November 1992 (Q92); cardiovascular diagnoses are based on general practice notifications to October 1992. A total of 5751 men aged 52-73 years (87% of survivors) completed questions on aspirin use. RESULTS: Overall, 547 men (9.5%) were taking aspirin daily, of whom 321 (59%) had documented CVD. Among men with pre-existing disease, 153 out of 345 (44%) men with myocardial infarction, 42 out of 109 (39%) with stroke, and 75 out of 247 (29%) with angina were taking aspirin daily. Among men with angina (54% versus 26%) or myocardial infarction (59% versus 42%), those who had undergone coronary artery bypass surgery (CABG) or angioplasty were more likely to be receiving aspirin. Higher rates of aspirin use were also found in those whose last major event occurred after January 1990 (47% versus 34%). There was no association between aspirin use and social class or region of residence. CONCLUSION: Despite strong evidence of its effectiveness, many patients with established CVD were not receiving aspirin. Daily aspirin treatment was less likely in men with less recent major CVD events and in those who had not received invasive treatment.

Cigarette smoking in British men and selection for coronary artery bypass surgery.

OBJECTIVE: To examine the relation between smoking status, clinical need, and likelihood of coronary artery bypass grafting in middle aged men. DESIGN: A prospective study of cardiovascular disease in British men aged 40 to 59 years, screened in 1978-80 and followed until December 1991. SUBJECTS AND SETTING: 7735 men drawn from one general practice in each of 24 British towns. MAIN OUTCOME MEASURE: Coronary artery bypass graft surgery. RESULTS: Of the 3185 current smokers, 38 (1.03/1000/year) underwent coronary artery bypass surgery compared with 47 of 2715 (1.45/1000/year) ex-smokers, and 19 of 1817 (0.85/1000/year) never-smokers. Ex-smokers had a lower incidence of major ischaemic heart disease during follow up than current smokers. After adjustment for incidence of ischaemic heart disease during follow up, the hazard ratio of coronary artery bypass surgery for ex-smokers compared with smokers was 1.52 (95% confidence interval 0.99 to 2.34). Ex-smokers were more likely at screening to recall a doctor diagnosis of ischaemic heart disease than smokers (7.1% v 5.3%), but among those who recalled a doctor diagnosis, smokers were less likely to undergo coronary artery bypass surgery than ex-smokers (9.4% v 3.5%, P = 0.026). By 1992, men defined as smokers at screening were no less likely than ex-smokers to have been referred to a cardiologist (18.5% v 18.8%), nor to report having undergone coronary angiography less frequently than ex-smokers (12.7% v 11.4%). CONCLUSION: Even allowing for the strong relation between coronary artery bypass surgery and clinical need, continuing smokers were less likely to undergo coronary artery bypass surgery than ex-smokers. A complex interplay exists between the men's experience of heart disease, the decision to stop smoking, and the willingness of doctors to consider coronary artery bypass surgery.

Students' knowledge and behavior concerning safer sex: a UK study.

Most students in institutions of further and higher education in the northeast of England who responded to a 1989 survey dealing with sexual behavior and safer sex were heterosexual and had been sexually active or intended to have sexual intercourse. Many students, however, believed that safer sex implied having no sex at all or were unaware of the role of nonpenetrative sex in preventing human immunodeficiency virus (HIV) infection. They did not use condoms, in spite of having positive attitudes about condom use, and they engaged in one or more sexual activities that increased the risk of acquiring HIV infection. In view of the increasing incidence of acquired immunodeficiency syndrome (AIDS), the authors assert, these findings are cause for concern and require concerted action by health educators and society to encourage safer sex practices and to prevent the spread of HIV infection.

PIP: 666 university students, 666 polytechnic students, and 542 college students in the Tyne-Tees area to the northeast of England were surveyed about safer sex and their sexual behavior. More than 47,000 full-time students attended 37 further and higher education establishments in the area in 1989. The survey was part of an evaluation of the 1989 Health Education Authority national initiative to increase students' awareness of HIV and AIDS through the use of information packs. 1388 responses were obtained from students of mean age 20.3 years. 97.7% considered themselves heterosexual, 72% were living away from home, and 70% had experienced penetrative sexual intercourse. Although the students were generally positive about condom use, only 19% always used condoms and 47% never did. Younger students aged 16-17 years tended to be the ones who used them consistently. Many had, however, modified their sexual behaviors because of publicity about AIDS. Those who had taken steps to reduce their risk of HIV infection were typically younger, women, and students in college. They had reduced the number of sex partners, become monogamous, reduced their participation in anal and casual sex and/or used condoms. The authors express concern over the finding that youths believe that safer sex implies abstinence and that many were unaware of the role of nonpenetrative sex in preventing HIV infection. Health educators and society are strongly urged to take measures capable of preventing further HIV infection.

The patient profile approach to assessing the cost of AIDS and HIV infection.

Despite interest in the costs associated with HIV infection, little useful information exists to aid those planning patient care. The results of costing studies, which are mainly North American, are difficult to apply to the National Health Service. Moreover, they have generally ignored HIV infection before formal diagnosis of AIDS. A patient profile approach was devised to supply data on the type, amount and cost of services supplied to patients in the Northern region. This method produces longitudinal treatment and cost profiles, and provides a temporal perspective, which is essential given the speed at which care has changed to date. This method also allows identification of a wide array of services, costs and social factors. This paper describes a pilot study to develop and test these methods. The sample of 24 randomly selected patients constituted a heterogeneous group; the individuals affected, the type and number of services supplied and costs all varied widely. A typical patient could not be described. Our results illustrate the powerful analyses which this approach permits. Further application will allow improved evaluation of the overall costs and the effects of different patterns of care.