Certain low-risk populations continue baby aspirin use, despite risk and clinical guidance
Key takeaways:
- Some Asian, Black and Mexican American adults at low ASCVD risk continue taking baby aspirin, despite risk and clinical guidance.
- Similar observations were reported for those on Medicaid or without insurance.
Many historically underrepresented groups, individuals on Medicaid and some without insurance at low atherosclerotic risk continue to take low-dose aspirin despite bleeding risk, in contrast to recent clinical guidance, researchers found.
Additionally, low-dose aspirin use declined among individuals with 10% or higher 10-year ASCVD risk, who may derive benefit, according to data published in JAMA.
“Many people are still taking a daily aspirin without proven clinical benefit,” Timothy S. Anderson, MD, MAS, assistant professor of medicine at the University of Pittsburgh and primary care physician at the University of Pittsburgh Medical Center, said in a press release. “Moreover, long-term aspirin use carries small but serious risks of bleeding.”
Updated aspirin guidelines
The 2019 American College of Cardiology/American Heart Association guideline on ASCVD primary prevention, published in Circulation, limited its recommendations for preventive aspirin use to patients with increased ASCVD risk who were aged 70 years or younger without elevated bleeding risk.
“When it comes to medications, more is not always more,” Anderson said in the release. “Clinicians are increasingly seeking to optimize medication usage by deprescribing medications with little proven benefit or elevated risks. It’s important to know who those efforts are benefiting and who we need to work harder to reach.”
To determine whether the updated aspirin recommendations impacted appropriate use per the guidelines, Anderson and Linnea M. Wilson, MPH, clinical researcher at Beth Israel Deaconess Medical Center in Boston, conducted an analysis of five cycles of the National Health and Nutrition Examination Survey from 2011 to 2023, including 18,294 nonpregnant adults aged 40 to 79 years (mean age, 57 years; 52% women; 68% white).
Aspirin use before and after guideline update
During the study period, aspirin use for secondary prevention in patients with ASCVD remained stable (P = .86), and there was a decline in reported aspirin use for primary prevention after the guidelines were updated in 2019 (23.5% vs. 17.2%; P < .001).
Among primary prevention subgroups, the researchers reported an average 11.7 percentage point decrease in aspirin use among adults aged 70 years or older (P < .001) and an average 5.7 percentage point decrease among adults with ASCVD risk less than 10% (P < .001).
However, among individuals for whom aspirin is not recommended for primary prevention, there was no significant change in use among Asian, Black or Mexican American individuals or those without a routine health care location, insured by Medicaid or without health insurance, according to the study.
Moreover, among individuals with ASCVD risk of 10% or greater for whom primary prevention aspirin may still be recommended, the researchers reported a decline in use after the 2019 guidelines (5.8 percentage points; P = .04).
“Following landmark clinical trials and changes in guideline recommendations, self-reported primary prevention aspirin use decreased among older adults and adults with low ASCVD risk for whom aspirin was not recommended, but also decreased among adults with higher ASCVD risk for whom aspirin may still be recommended,” Wilson and Anderson wrote in the study. “Furthermore, historically disadvantaged groups were less likely to reduce aspirin use. ... Further attention to reducing low-value aspirin use is warranted given 2022 recommendations by the U.S. Preventive Services Task Force against initiating primary prevention aspirin in patients 60 years and older, which may have also contributed to observed change.”
As Healio previously reported, in 2022, the U.S. Preventive Services Task Force issued its final recommendation against low-dose aspirin initiation for primary CVD prevention in adults aged 60 years or older and issued a C-grade recommendation that low-dose aspirin for primary CVD prevention be considered on a case-by-case basis among those aged 40 to 59 years with a 10% or higher ASCVD risk.
References:
- Arnett DK, et al. Circulation. 2019;doi:10.1161/CIR.0000000000000678.
- Racial minorities, Medicaid recipients more likely to take daily ‘baby aspirin,’ despite risks. https://www.medschool.pitt.edu/news/racial-minorities-medicaid-recipients-more-likely-take-daily-baby-aspirin-despite-risks. Published Jan. 22, 2025. Accessed Jan. 27, 2025.
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