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Is Aspirin Overused for Primary Prevention of Cardiovascular Disease?


January 29, 2015

Many Americans take aspirin unnecessarily to stave off cardiovascular disease (CVD), according to new research, which touched on an important opportunity to improve upon the evidence-based use of the common drug for primary prevention of CVD. 

Guidelines issued in 2011 by the AHA and American Stroke Prevention Association that recommend aspirin use for patients with at least a 6% risk of CVD over 10 years, said study, which noted the U.S. Food and Drug Administration warned against the use of aspirin as the primary prevention of heart attacks and stroke, and refused to allow aspirin to be marketed for heart attack prevention.

The current analysis showed that more than 10% of the nearly 70,000 patients who received aspirin for primary CVD prevention had less than a 6% 10-year risk of a cardiovascular event. The average 10-year risk was 4% in patients who received aspirin unnecessarily compared with 24.5% in patients who received the drug as indicated. The findings remained consistent after excluding diabetics, statin users, and women older than 65 years — who should receive aspirin for primary CVD prevention, according to the American Heart Association (AHA).

Most patients who were prescribed aspirin inappropriately were women and tended to be younger, which did not surprise the researchers, who said older men are typically at increased 10-year risk of CVD, and therefore more likely to receive aspirin appropriately.

According to the study, more than 90% of patients with established CVD receive aspirin at the time of hospital discharge for the largely effective benefit of preventing heart attack, stroke, and death. But the potential benefit of reducing those risks in patients without CVD and at low 10-year risk of cardiovascular events does not outweigh the increased dangers of gastrointestinal (GI) bleeding and stroke, noted the researchers.

Inappropriate use of aspirin among the cardiology practices the patients visited for care ranged from 0% to 71.8%, said the study, which suggested a patient was 63% more likely to receive aspirin inappropriately than another patient based simply on where they were treated.

“Medical providers must consider whether the risk of bleeding outweighs the potential benefit of prescribing aspirin to patients who don’t yet meet the guideline recommendations for receiving the therapy,” said study lead author Dr. Ravi Hira, of the department of cardiology at Baylor College of Medicine in Houston. “Since aspirin is available over the counter, patient and public education against using aspirin without proper recommendation will also play a key role in avoiding inappropriate use.”

The study was published in the Journal of the American College of Cardiology.

 

—Dan Cook

 

Reference:

1. Hira RS, Kennedy K, Nambi V, et al. Frequency and practice-level variation in inappropriate aspirin use for the primary prevention of cardiovascular disease. J Am Coll Cardiol. 2015;65(2):111-121.

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