January 12th, 2015
High Rate of Inappropriate Use of Aspirin for Primary Prevention
More than a third of U.S. adults — more than 50 million people — now take aspirin for the primary and secondary prevention of cardiovascular disease. Although it was once broadly recommended, aspirin for the primary prevention of cardiovascular disease is now only indicated in people who have a moderate-to-high 10-year risk. Now a new report published in the Journal of the American College of Cardiology finds that there are still a significant number of people who are receiving aspirin inappropriately.
Different medical groups have various recommendations about the precise indications for aspirin for primary prevention, but there is broad agreement that aspirin is not appropriate in people who are at low risk, defined as a 10-year risk below 6%. Using data from more than 68,000 primary-prevention patients receiving aspirin who were followed in the National Cardiovascular Disease Registry Practice Innovation and Clinical Excellence (PINNACLE) Registry, researchers calculated that 11.6% of the patients had a 10-year risk below 6%. Women were more likely than men to receive aspirin inappropriately. Inappropriate use varied significantly at the practice level, ranging from 7.2% in the lowest quartile to 13.6% in the upper quartile. People who received aspirin inappropriately were 16 years younger, on average, than people who received aspirin appropriately. Over time the rate of inappropriate use has declined, from 14.5% in 2008 to 9.1% in 2013.
“Our findings suggest that there are important opportunities to improve evidence-based use of aspirin for primary CVD prevention.” the authors concluded.
In an accompanying editorial, Freek Verheugt expresses concern that “the benefit of aspirin may be overshadowed by the bleeding hazard,” especially since the bleeding risk appears to be strongly correlated to the ischemic risk of the patient. He further speculates that because for many patients statins and other drugs will have already produced a substantial reduction in risk, any benefit from aspirin will have been almost completely eliminated.