Increasing aspirin use among persons at risk for cardiovascular events in Oklahoma.

BACKGROUND: Cardiovascular disease (CVD), including coronary heartdisease (CHD)and stroke, is the leading cause of death in the United States and in Oklahoma; Oklahoma ranks 48th worst in CVD deaths.This paper will present Oklahoma-specific data and review current recommendations regarding aspirin use for the prevention of CVD events. METHODS: Average annual age-adjusted death rates were calculated. Oklahoma Behavioral Risk Factor Surveillance System (BRFSS) data were used to determine past history of CHD, risk factors for CHD and stroke, and aspirin use among persons 45 years and older. A literature review of recommendations regarding aspirin use was conducted. RESULTS: Between 2005-2008, 14.8% of Oklahomans 45 years of age and older reported a history of coronary heart disease and 6.4% a history of stroke. Approximately 50% of Oklahomans 45 years and older reported a history of hypertension and hypercholesterolemia; 21.5% were current smokers and 16.0% had diabetes. Nearly 10,000 Oklahomans die annually from CHD or stroke. The United States Preventive Services Task Force recommends 81mg per day of aspirin for men 45 to 79 and women 55 to 79 years of age unless they are at risk for bleeding complications. Daily aspirin use in Oklahoma was 44-57% among those with risk factors but no history of CHD or stroke. Fewer than 50% of Oklahomans 45-79 years reported being counseled by a health professional to take aspirin. Among those persons without a history of CVD who were counseled by a healthcare professional regarding aspirin, 79% were taking daily aspirin compared to 18% among persons not counseled. Aspirin sales increased significantly in Stephens County following a multifaceted community-based aspirin campaign. CONCLUSION: Low-dose aspirin is being underutilized as a strategy for reducing the excessive numbers of cardiovascular events and deaths in Oklahoma. Health professionals play an important role in educating patients about appropriate use of low-dose aspirin. Community-based interventions can also be effective.

Aspirin use in the prevention of cardiovascular events.

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death in the United States and Oklahoma, and Oklahoma ranks 50th in CVD deaths. This paper will describe CVD and coronary heart disease (CHD) mortality in Oklahoma and review current recommendations regarding aspirin use for the prevention of CHD events. METHODS: The CDC Compressed Mortality File for 1999-2004 was accessed. Average annual age-adjusted or age-specific death rates per 100,000 population were calculated. A literature review of data and recommendations regarding aspirin use was conducted. RESULTS: From 1999-2004, there were 50,170 CHD deaths in Oklahoma (age-adjusted rate 232.1 per 100,000). Persons 75 years and older, males, and blacks had the highest death rates; the death rates declined for all persons except those aged 35-54 years. Aspirin use has been shown to be effective in reducing the number of nonfatal myocardial infarction (MI) and fatal CHD, though studies of aspirin effects in women have found a significant reduction in ischemic stroke but no significant effect on fatal or nonfatal MI or CVD death. Aspirin use slightly increases rates of gastrointestinal bleeding and hemorrhagic stroke. CONCLUSION: Continued commitment to counseling patients regarding tobacco cessation, nutrition and exercise, and treatment to reduce blood pressure, cholesterol, tobacco use, and blood sugar are essential. The Oklahoma State Medical Association Physicians Campaign for a Healthy Oklahoma has made it a priority to increase awareness of the risk and benefits of aspirin use among high-risk persons. Oklahoma physicians should assess patients at highest risk, such as healthy men older than 40 years, postmenopausal women (especially >or= 65 years), and younger people with risk factors for coronary heart disease (e.g., hypertension, hyperlipidemia, diabetes, or smoking) and discuss the potential benefits and harms of aspirin use.

Within-day drinking water consumption patterns: results from a drinking water consumption survey.

Data currently available on drinking water intakes do not support dietary exposure estimates for contaminants that have acute effects lasting less than 24 h. Realistic exposure estimates for these types of contaminants in drinking water require detailed information on amounts and time of consumption for each drinking occasion during a day. A nationwide water consumption survey was conducted to address how often, when, and how much water is consumed at specific times during the day. The survey was conducted in two waves, to represent two seasons, and the survey instrument consisted of 7-day water consumption diaries. Data on total daily amounts consumed, number of drinking occasions per day, amounts consumed per drinking occasion, and intervals between drinking occasions show larger between-subjects variation than within-subject variation. Statistically significant associations were also observed between drinking water consumption patterns and participants' ages and sex and geographical regions in which these participants live. The number of drinking occasions on a given day varied from 0 to 19, with the majority of respondents reporting 6 or less drinking occasions per day. The average interval between drinking occasions varied from 1 to 17 h, with 57% of the person-days reporting average intervals at least 3 h apart. The mean amount consumed per drinking occasion showed little association with the number of drinking occasions and fluctuated between 8 and 10 oz. To our knowledge, this survey is the only source of information on within-day patterns (i.e., when and how much) of drinking water consumption for a nationally representative sample of the US population. The detailed water consumption data from this survey can be used to support less than 24-h dietary exposure estimates for contaminants in drinking water.