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Aspirin overutilization for the primary prevention of cardiovascular disease
Jeffrey J VanWormer1, Aaron W Miller2, Shereif H Rezkalla3
1Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Foundation, Marshfield, WI, USA.
Insights
Aspirin is overused for primary cardiovascular disease prevention in the US. Older age and frequent medical visits are key predictors of inappropriate aspirin use, especially in obese individuals.
Area of Science:
- Cardiology
- Preventive Medicine
- Public Health
Background:
- Aspirin is widely used for primary prevention of cardiovascular disease (CVD) in the US.
- Previous studies indicated inappropriate aspirin use in European populations.
- The extent of aspirin overutilization in the US was previously unknown.
Purpose of the Study:
- To examine the association between regular aspirin use and demographic/clinical factors.
- To assess aspirin overutilization in a US population without a clinical indication for primary CVD prevention.
Main Methods:
- Cross-sectional analysis of 2010-2012 data from adults aged 30-79.
- Defined regular aspirin users as those taking aspirin at least every other day.
- Analyzed data from the Marshfield Epidemiologic Study Area (WI, USA).
Main Results:
- 19% of 16,922 individuals without a CVD indication were regular aspirin users.
- Older age, male sex, northern Wisconsin residency, frequent medical visits, and higher BMI predicted regular aspirin use.
- Race/ethnicity, insurance, smoking, blood pressure, and lipids had minimal impact.
Conclusions:
- Evidence of aspirin overutilization exists in the US population without CVD.
- Older age and frequent provider visits were the strongest predictors of inappropriate aspirin use.
- Obesity was a significant clinical factor, highlighting a potential misalignment in perceived benefits versus risks.
Background:
Aspirin is commonly used for the primary prevention of cardiovascular disease (CVD) in the US. Previous research has observed significant levels of inappropriate aspirin use for primary CVD prevention in some European populations, but the degree to which aspirin is overutilized in the US remains unknown. This study examined the association between regular aspirin use and demographic/clinical factors in a population-based sample of adults without a clinical indication for aspirin for primary prevention.
Methods:
A cross-sectional analysis was performed using 2010-2012 data from individuals aged 30-79 years in the Marshfield Epidemiologic Study Area (WI, USA). Regular aspirin users included those who took aspirin at least every other day.
Results:
There were 16,922 individuals who were not clinically indicated for aspirin therapy for primary CVD prevention. Of these, 19% were regular aspirin users. In the final adjusted model, participants who were older, male, lived in northern Wisconsin, had more frequent medical visits, and had greater body mass index had significantly higher odds of regular aspirin use (P<0.001 for all). Race/ethnicity, health insurance, smoking, blood pressure, and lipid levels had negligible influence on aspirin use. A sensitivity analysis found a significant interaction between age and number of medical visits, indicating progressively more aspirin use in older age groups who visited their provider frequently.
Conclusion:
There was evidence of aspirin overutilization in this US population without CVD. Older age and more frequent provider visits were the strongest predictors of inappropriate aspirin use. Obesity was the only significant clinical factor, suggesting misalignment between perceived aspirin benefits and cardiovascular risks in this subgroup of patients. Prospective studies that examine cardiac and bleeding events associated with regular aspirin use among obese samples (without CVD) are needed to refine clinical guidelines in this area.
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