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Low-dose aspirin therapy for cardiovascular prevention: quantification and consequences of poor compliance or
Johan Herlitz1, Peter P Tóth, Jørgen Naesdal
1Sahlgrenska University Hospital, Gothenburg, Sweden. johan.herlitz@gu.se
Insights
Low-dose aspirin (acetylsalicylic acid) therapy is crucial for preventing cardiovascular events. However, poor patient compliance and treatment discontinuation are common, increasing risks and necessitating interventions to improve adherence.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Low-dose aspirin (acetylsalicylic acid; ASA) is a cornerstone for secondary cardiovascular (CV) event prevention.
- Continuous therapy and good patient compliance are vital for maximizing the benefits of long-term low-dose ASA treatment.
Purpose of the Study:
- To quantify patient-driven non-compliance and treatment discontinuation rates with low-dose ASA.
- To identify key factors contributing to non-compliance and discontinuation in patients undergoing ASA therapy for CV event prevention.
Main Methods:
- Systematic literature search of PubMed, Embase, and Cochrane databases up to July 2008.
- Inclusion of 32 studies encompassing over 144,800 patients to analyze compliance and discontinuation data.
Main Results:
- Reported low-dose ASA non-compliance varied widely (10%–50%+), with patient-initiated discontinuation reaching up to 30%.
- Predictors of non-compliance and discontinuation included lower education, female sex, depression, diabetes, and smoking.
- Adverse events were the primary reason for discontinuation, cited by nearly 50% of patients.
Conclusions:
- Substantial rates of non-compliance and discontinuation with low-dose ASA therapy pose significant risks for CV events.
- Addressing patient-reported barriers, particularly adverse events, is essential for healthcare professionals to enhance CV risk management through improved ASA adherence.
Abstract:
Long-term therapy with low-dose aspirin (acetylsalicylic acid; ASA), 75-325 mg, is highly effective for the secondary prevention of cardiovascular (CV) events. For high-CV-risk patients to attain the full benefits of this therapy, it is important that treatment is continuous and that good compliance is maintained over the long term. We aimed to quantify the level of, and investigate the reasons for, patient-driven non-compliance and treatment discontinuation among patients taking low-dose ASA for the prevention of CV events. We therefore performed a systematic search of the PubMed, Embase, and Cochrane databases using the terms 'aspirin' AND 'patient compliance' OR 'withdrawal', with no restrictions on the start date and up to July 2008. A total of 32 studies, summarizing >144 800 patients, were selected from over 400 results for inclusion. Poor compliance (defined differently among the studies included) with low-dose ASA therapy ranged from approximately 10% to over 50%, and patient-initiated discontinuation of therapy occurred in up to 30% of patients. Common predictors of both non-compliance and treatment discontinuation were lower education level, female sex, or a history of depression, diabetes mellitus, or cigarette smoking. Adverse events were cited as the reason for low-dose ASA discontinuation in almost 50% of patients. The findings of this review suggest that poor compliance is common among patients receiving low-dose ASA therapy, placing them at substantial risk of CV events. By addressing barriers to compliance with low-dose ASA therapy, healthcare professionals can improve CV risk management for such patients.
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