Many older adults still use aspirin for CVD prevention, contrary to clinical guidance

Key takeaways:

• Nearly one in 20 adults aged 60 years and older without CVD used aspirin without medical advice.
• The findings underscore the need to reduce inappropriate aspirin use in older adults.

Almost one-third of adults aged 60 years and older without CVD regularly used aspirin for primary prevention in 2021, contrary to guidance from medical organizations, a study showed.

The data, published in the Annals of Internal Medicine, build on previous research that shows older adults continue to use aspirin for primary CVD prevention.

“In my clinical practice, I often observed older patients without a history of CVD taking preventive aspirin,” Mohak Gupta, MD, an internal medicine resident at the Cleveland Clinic, told Healio. “This led us to conduct this study to understand the prevalence of preventive aspirin use in the United States, and if this changed after new evidence emerged in 2018.”

According to Gupta and colleagues, a 2018 randomized controlled trial found that aspirin use for primary CVD prevention had limited benefits in older adults.

These findings prompted the American College of Cardiology and the American Heart Association to issue guidance in 2019 advising against the use of regular aspirin in adults aged 70 years and older, in those without a history of CVD and in those at an increased risk for bleeding.

The U.S. Preventive Services Task Force issued similar guidance in 2022, recommending against low-dose aspirin for primary CVD prevention in adults aged 60 years and older. The task force said the decision to initiate aspirin should be made on a case-by-case basis in adults aged 40 to 59 years with a 10% or greater 10-year CVD risk.

In the current study, the researchers assessed 2012 to 2021 National Health Interview Survey Sample Adult data on aspirin use and related medical advisement.

The study cohort included 186,425 participants aged 40 years and older (52.6% women), representing around 150 million adults annually.

Gupta and colleagues found that aspirin use was higher among older adults and those with multiple cardiovascular risk factors.

In 2021, 18.5% of adults aged 40 years or older and 29.7% of those aged 60 years or older without CVD reported aspirin use for primary prevention.

“This is a critical finding because routine use of primary prevention aspirin in this age group is no longer recommended, as this may cause net harm due to increased bleeding,” Gupta said.

Among those aged 60 years or older, 5.2% used aspirin without medical advice.

“This means we may be missing the opportunity to discuss risks and benefits of aspirin use in these patients and highlights the need to ask our older patients if they are self-using aspirin,” Gupta explained.

The researchers noted that aspirin use for primary prevention declined “minimally” between 2012 to 2017, but a larger decrease was seen following 2018, especially among those aged 60 years and older.

Medically advised aspirin use was lower in 2021 compared with 2012 to 2017, with the prevalence decreasing from:

• 31.2%-27.6% to 19.3% among adults aged 60 to 69 years; and
• 41.6%-38.35% to 31.2% among adults aged 70 years and older.

Aspirin use without medical advice was also lower after 2018 among adults aged 70 years and older, declining from 7% to 4.5%.

Among adults who did not take aspirin despite a physician’s initial recommendation, 44.5% were eventually advised by a physician to stop aspirin use for primary prevention in 2021 vs. 30% in 2012 to 2017.

The study had several limitations, according to the researchers. For example, there was a lack of required data to estimate CVD or bleeding risk, “which informs decisions about aspirin use,” they wrote.

Additionally, because data were self-reported, the findings are susceptible to recall bias.

Ultimately, physicians “should ask about aspirin self-use, engage in risk-benefit discussions with older patients using aspirin for primary prevention, and discontinue aspirin where appropriate,” Gupta said. “Preventive aspirin may still be considered for certain younger adults who have a high cardiovascular risk and low bleeding risk after discussing the patient's preferences and values and assessing benefits and risks carefully.”

References:

• Arnett K, et al. J Am Coll Cardiol. 2019;doi:10.1016/j.jacc.2019.03.010.
• Aspirin use to prevent cardiovascular disease: Preventive medication. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/aspirin-to-prevent-cardiovascular-disease-preventive-medication. Accessed June 20, 2024.
• Gupta M, et al. Ann Intern Med. 2024;doi:10.7326/M24-0427.