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Im et al. Vessel Plus 2018;2:5 I http://dx.doi.org/10.20517/2574-1209.2018.07 Page 5 of 7

Table 4. Logistic regression analysis for the factors of ASCVD risk calculation and taking aspirin
ASCVD risk calculation factors OR (95% CI) P value
Men 1.64 (0.79-3.35) 0.179
Age 1.05 (0.99-1.12) 0.106
HDL-cholesterol 0.98 (0.94-1.01) 0.124
Total cholesterol 0.99 (0.98-1.01) 0.346
Treatment for hypertension 7.49 (3.62-15.49) < 0.0001*
Systolic blood pressure 0.98 (0.96-1.01) 0.179
Cigarette smoker 0.59 (0.24-1.42) 0.236
Diabetes 1.27 (0.56-2.86) 0.565
ASCVD: atherosclerotic cardiovascular disease; OR: odds ratio; CI: confidence interval; HDL: high density
lipoprotein. Significant P is marked with *

DISCUSSION
Based on the ACC/AHA ASCVD risk estimator and the 2016 USPSTF recommendations, this study
demonstrated that aspirin was indicated in 23.6% of the participants undergoing medical check-up but only
6% of the participants were taking it appropriately. These results are similar to previous findings that showed
the frequency of aspirin use [9-11] . The role of aspirin in primary prevention among individuals without known
CVD is currently unclear [2,4,12] . However, high-risk patients who are not receiving aspirin are at an increased
risk of CVD events. Low-risk patients are also exposed to the adverse bleeding risk with unnecessary use of
aspirin. For primary prevention of CVD, decisions regarding aspirin use should be highly individualized .
[13]
An alternative approach that may be helpful in determining the risk and benefit from aspirin therapy is
using a risk assessment tool. It is helpful that healthcare providers will be able to estimate the CVD risk for
an individual patient.

In this study, logistic regression analysis revealed that though SBP did not have any effect on the aspirin
use (OR 0.98; 95% CI 0.96-1.01), treatment for hypertension was strongly associated with taking aspirin. It
might be related with doctor’s coprescription of aspirin with antihypertensive drugs in outpatient clinic,
suggesting that there may be an opportunity for decreasing the rate of CVD as well as the risk for major
bleeds through tailored education for physicians on aspirin use. Our study also showed that there was a
trend toward taking aspirin with men and aging. Advancing age is a well-known non-modifiable risk factor
for CVD. The cumulative effects of aging substantially increase the CVD risk, but the burden of CVD risk
can be reduced in part by the modification of traditional risk factors . A higher frequency of diabetes and
[14]
smoking in men may be associated with these results as well. Potentially modifiable risk factors, such as
hypertension, diabetes, dyslipidemia, tobacco use, and physical inactivity, account for most of the risk of
CVD [15,16] . Medications to control blood pressure and lipids, smoking cessation, diet, and exercises are the
interventions broadly applicable to the general population. There is another chance for decreasing the rate of
CVD through personalized education for individuals on modifiable risk factors. The optimization of CVD
prevention for individuals can identify and achieve the control of risk factors safely, expeditiously, and cost-
effectively.

In our study, the mean IMT was significantly greater in the ≥ 10% 10-year CVD risk group than in the < 10%
10-year CVD risk group. Several longitudinal studies have demonstrated that an increased carotid IMT can
have an independent, synergistic risk prediction power for stroke and MI . While a carotid ultrasonography
[17]
screening policy is not warranted in the general population, it might be considered in subjects with a higher
10-year CVD risk to better stratify their actual risk [18,19] . Further studies are required to address the role of
carotid ultrasonography in primary prevention of vascular events in high-risk subjects.

There were several limitations in this study. The most important limitation was that aspirin use was determined
based on a self-report and this might have led to an underestimation of the actual use. The socioeconomic
status was not determined and this could have resulted in overestimation of the number of individuals in