Aspirin use for primary ASCVD prevention common in older adults despite guidelines
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Aspirin use for primary atherosclerotic CVD prevention continues to be prevalent in adults aged 70 years or older despite contrary guideline recommendations, according to data published in the American Journal of Preventive Cardiology.
“Despite the slight declines in use over the last decade, aspirin is still widely utilized for ASCVD prevention among U.S. adults,” Ellen Boakye, MD, MPH, CPH, a postdoctoral fellow at the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, and colleagues wrote. “A significant proportion of older adults aged at least 70 years reported using aspirin for primary ASCVD prevention.”
According to the study background, the use of aspirin for secondary prevention is recommended due to its benefits in reducing vascular mortality, but documents such as the primary prevention guideline from the American College of Cardiology and the American Heart Association discourage its use for primary prevention, particularly among low- and intermediate-risk adults aged 70 years or older.
The researchers used the 1998-2019 Behavioral Risk Factor Surveillance System data to assess aspirin use in 54,388 adults aged 40 years or older and to determine links between aspirin use and ASCVD risk factors including hypertension, diabetes, high cholesterol, overweight/obesity and cigarette smoking.
The researchers found that despite an increase in aspirin use from 29% (95% CI, 27.9-30.2) to 37.5% (95% CI, 36.9-38) from 1998 to 2009, there was a decrease from 35.6% (95% CI, 34.6-36.6) to 33.5% (95% CI, 32.5-34.6) from 2011 to 2019. In 2019, among the cohort, 27.5% of those without CVD reported primary prevention aspirin use while 69.7% of those with CVD reported secondary prevention aspirin use.
Notably, in 2019, 45.6% (95% CI, 43.5-47.7) of participants aged 70 or older without CVD reported primary prevention aspirin use, a statistic the researchers wrote was “of concern.”
Among individuals without self-reported ASCVD risk factors, men were more likely to report primary prevention aspirin use than women (adjusted OR = 1.6; 95% CI, 1.12-2.27), adults aged 70 years or older were more likely to report it than those aged 40 to 69 years (aOR = 3.22; 95% CI, 2.27-4.55), and individuals with health care coverage were more likely to report it than those without health care coverage (aOR = 2.28; 95% CI, 1.17-4.44), according to the researchers.
“Given that the 2019 ACC/AHA guidelines explicitly advise against aspirin use for primary prevention among adults aged at least 70 years, such use should be discontinued and discouraged,” the researchers wrote. “Persons aged at least 70 years are at an increased risk of bleeding and, hence, may have a less favorable benefit-risk ratio with primary prevention aspirin use.”
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