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Half of older adults take aspirin for CVD prevention despite recommendations

Almost half of people aged 70 years and older who do not have CVD take aspirin to prevent cardiovascular disease despite guidelines that recommend against the practice, according to findings published in the Annals of Internal Medicine.

Results from three randomized control trials published in 2018 that assessed aspirin for primary prevention of cardiovascular disease in adults — ASCEND, ARRIVE, and ASPREE — showed that taking aspirin had few benefits, led to consistent bleeding risks and was tied to increased mortality in older adults, according to study authors.

“In light of these findings, in March 2019, the American Heart Association and American College of Cardiology (AHA/ACC) released updated guidelines, which now recommend against routine aspirin use in persons older than 70 years and those with increased bleeding risk,” Colin W. O’Brien, MD, of Harvard Medical School, and colleagues wrote.

To determine the extent of aspirin use to prevent CVD in U.S. adults, researchers collected data from a nationally representative survey of health and disability among adults in the United States. The survey asked participants aged 40 years and older if a health care provider advised them to take low-dose aspirin every day to prevent or control heart disease, if they subsequently took aspirin every day, or if they independently chose to take low-dose aspirin daily.

A total of 14,328 adults with a mean age of 57.5 years were included in the study. Among those aged 40 years and older who did not have CVD, 23.4% took aspirin daily to prevent CVD. Of those, 22.8% did so without recommendation from a health care professional.

Researchers found that almost half of adults aged 70 years or older who did not have CVD reported using aspirin.

Aspirin use was significantly associated with older age, male sex and CVD risk factors including hypertension, hyperlipidemia, diabetes and smoking. Those with a history of peptic ulcer disease did not have lower aspirin use.

The findings suggest that many adults may take aspirin without their physician’s advice or knowledge, according to researchers.

“In light of recent trials and guidelines, our findings show a tremendous need for health care practitioners to inquire about ongoing aspirin use and to counsel patients about the balance of benefits and harms, especially among older adults and those with prior peptic ulcer disease,” O’Brien and colleagues wrote. – by Erin Michael

Disclosures: O’Brien reports no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.