Almost One-Third of Older Adults Using Aspirin for Primary Prevention of CVD: Study
The use of aspirin for primary prevention of cardiovascular diseases (CVD) is against medical guidance for adults aged 60 years and older, according to a study published in the Annals of Internal Medicine. The research conducted by Mohak Gupta and colleagues aimed to understand the prevalence of preventive aspirin use in the US and analyzed the National Health Interview Survey Sample Adult data on aspirin use and related medical advisement from 2012 to 2021. The study found that in 2021, 29.7% of adults aged 60 years or older without CVD use aspirin for primary prevention. Moreover, among those aged 60 years or older, 5.2% of participants 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,” said Gupta.
Current Medical Guidance on Aspirin Use for Primary CVD Prevention
According to the American College of Cardiology and the American Heart Association, regular aspirin use is not recommended for adults aged 70 years and older, those without a history of CVD, and those at an increased risk for bleeding since a 2018 randomized controlled trial found that aspirin use for primary CVD prevention had limited benefits in older adults. The U.S. Preventive Services Task Force recommended against low-dose aspirin for primary CVD prevention in adults aged 60 years and older. The decision to initiate or terminate 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.
Impact of Aspirin Use on Older Adults with Multiple Cardiovascular Risk Factors
The study found that aspirin use was higher among older adults and those with multiple cardiovascular risk factors. As a result, routine use of primary prevention aspirin in this age group may cause net harm due to increased bleeding. Gupta advises physicians to ask about aspirin self-use and engage in risk-benefit discussions with older patients using aspirin for primary prevention. Moreover, 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.
The Prevalence of Medically Advised Aspirin Use
The data revealed that medically advised aspirin use was lower in 2021 compared with 2012 to 2017. The prevalence of aspirin use declined minimally between 2012 and 2017, but a more significant decrease was seen following 2018, particularly among those aged 60 years and older. 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 versus 30% in 2012 to 2017.
Conclusion
The study highlights the need for healthcare professionals to discourage the routine use of aspirin in older adults without a history of CVD. Aspirin use may result in increased bleeding risk and may not provide significant benefits. Physicians should engage in risk-benefit discussions with older patients using aspirin for primary prevention and discontinue aspirin if appropriate. Preventive aspirin may still be an option for certain younger adults with a high cardiovascular risk and low bleeding risk after careful assessment of the benefits and risks involved.
Originally Post From https://www.healio.com/news/primary-care/20240624/many-older-adults-still-use-aspirin-for-cvd-prevention-contrary-to-clinical-guidance
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