• NHIS Data: Millions Self-Prescribe Aspirin for CVD Prevention

    Primary care providers would do well to ask patients about it

    Many American adults were taking aspirin for primary prevention without their doctors' recommendation or even their knowledge, recent federal survey data indicated.

    Results from the in-person 2017 National Health Interview Survey showed that 23.4% of U.S. adults ages 40 and older said they were taking low-dose aspirin "to prevent or control heart disease" -- and of those, 22.8% were doing so without a physician's recommendation, according to Christina Wee, MD, MPH, of Beth Israel Deaconess Medical Center and Harvard Medical School, and colleagues.

    That equates to about 6.6 million people taking aspirin for primary prevention without having discussed it with their doctors, the researchers reported in an Annals of Internal Medicine research brief. Respondents whose data were included in the analysis had no self-reported history of angina, coronary heart disease, MI, or stroke.

    Among those age 70 years or older, daily aspirin with or without a physician's recommendation was even more widespread: nearly half said they were taking low-dose aspirin for primary prevention. (Wee and colleagues did not report how many of them did so on their own initiative.)

    Predictors of aspirin use were older age, male sex, and cardiovascular risk factors. Notably, history of peptic ulcer disease was not a negative predictor of aspirin use, Wee's group found.

    "Nearly 30 million U.S. adults aged 40 years or older use aspirin to prevent CVD [cardiovascular disease], including nearly half of older adults without self-reported CVD and a quarter of adults without CVD but with a history of peptic ulcer disease," the investigators estimated from their findings.

    Aspirin use has been linked to little (if any) benefit in cardiovascular disease and consistent bleeding risk, most recently in 2018's ASCEND, ARRIVE, and ASPREE trials.

    In March 2019, the American Heart Association and American College of Cardiology released updated guidelinesrecommending against routine aspirin use in people older than 70 years and those with increased bleeding risk.

    For the study, Wee and colleagues included 14,328 people (mean age 57.5, 54% women, 33% non-white).

    Dominick Angiolillo, MD, PhD, of University of Florida Health Jacksonville, told MedPage Today that these results are no surprise. For many years, he said, there's been the perception that low-dose aspirin can reduce strokes and heart attacks with little risk of harm -- the reasoning being it's "just" low-dose aspirin.

    Keeping in mind that these data and guidelines were just recently published, "it just takes time, like in many therapeutic areas, for changes to occur in practice patterns as well as general opinion in the community," Angiolillo said in an interview.

    Wee's group acknowledged the limitations of relying on self-reported data and including no younger adults in their study. "Finally, we were unable to calculate atherosclerotic CVD risk scores because blood pressure and cholesterol levels were not measured."

    "In summary, aspirin use in the United States is widespread among groups at risk for harm. 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," they concluded.

    There should be more emphasis in primary care to ask if patients are taking low-dose aspirin, Angiolillo urged, adding that physician assistants and other non-physician providers should be made aware of the issue in their training.

     

    The study was supported by a NIH grant.

    Wee and Angiolillo disclosed no conflicts of interest.

    Source:

    Annals of Internal Medicine

    Source Reference: O'Brien CW, et al "Prevalence of aspirin use for primary prevention of cardiovascular disease in the United States: results from the 2017 National Health Interview Survey" Ann Intern Med 2019; DOI: 10.7326/M19-0953.

     

    Read the original article on Medpage Today: NHIS Data: Millions Self-Prescribe Aspirin for CVD Prevention

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