Aspirin Prophylaxis for the Primary Prevention of Myocardial Infarction

Cardiovascular diseases are the leading causes of death in the U.S., with a mortality rate in 1993 of 366.3/100,000 population.1 There are approximately 1.5 million myocardial infarctions (MIs) annually and nearly 500,000 deaths from ischemic heart disease.1,2 Each year, about 150,000 Americans die from stroke.1,2 The cost to the U.S. of medical care and lost productivity due to cardiovascular diseases was estimated at $117.4 billion in 1990.2 MI and sudden death often occur without warning in persons with no history of angina pectoris or other cardiovascular symptoms. The principal risk factors for coronary heart disease are smoking, high blood pressure, elevated serum cholesterol, obesity, diabetes mellitus, physical inactivity, increased age, male sex, and a family history of premature coronary artery disease. Postmenopausal hormone replacement is associated with reduced risk of coronary heart disease in women (see Chapter 68).