Many older adults use aspirin for primary prevention despite guideline changes
In 2021, nearly 30% of adults ages 60 years and older used aspirin for primary cardiovascular disease prevention despite 2018/2019 guideline updates from the American College of Cardiology and the American Heart Association.
Aspirin use for primary prevention of cardiovascular disease (CVD) remains common, especially among older U.S. adults, despite 2018/2019 guideline updates from the American College of Cardiology and the American Heart Association discouraging aspirin use for primary prevention in adults older than age 70 years, new research shows.
To better understand trends in aspirin use for CVD prevention among U.S. adults, researchers assessed data from the National Health Interview Survey from 2012 to 2019 and 2021. All participants were at least 40 years of age, and the sample was stratified based on age group and CVD status, including a self-reported history of stroke, myocardial infarction, coronary artery disease, or angina. Findings were published as a brief research report by Annals of Internal Medicine on June 25.
A total of 186,425 participants (52.6% female) were included in the study. Aspirin use tended to be higher in older adults and those with multiple cardiovascular risk factors. Data from 2021 show that 18.5% of adults ages 40 years and older took aspirin for primary prevention, rising to 29.7% among those ages 60 years and older, representing 18.5 million older adults, the researchers noted. Of those, 5.2% were taking aspirin without medical advice.
Between 2012 and 2017, aspirin use for primary prevention declined minimally, while larger decreases were seen after 2018, especially among those ages 60 years and older. Medically advised aspirin use was lower in 2021 than in 2012 to 2017, with prevalences of 19.3% versus 27.6% to 31.2% among adults ages 60 to 69 years and 30.6% versus 38.35% to 41.6% among adults ages 70 years or older.
The findings suggest that since the 2018/2019 guideline changes, "more physicians are recommending discontinuation of aspirin therapy for primary prevention," the study authors wrote. Despite these declines, nearly one third of adults ages 60 years and older without CVD still used aspirin in 2021, while around 1 in 20 were using aspirin without medical advice.
One limitation to the study is that researchers did not have access to data on use of P2Y12 inhibitors and anticoagulants. They also lacked data to estimate CVD or bleeding risk.
Overall, "our findings highlight the urgent need for physicians to inquire about aspirin use, including self-use, and engage in risk–benefit discussions to reduce inappropriate use for primary prevention in older adults," the authors concluded.