Key result
Higher cardiovascular risk is linked to ~15% higher prescribed aspirin use for primary prevention.
Why the study?
Aspirin use for cardiovascular indications remains widespread despite evidence not supporting its use in patients without cardiovascular disease.
What are the prevalence and patient factors (including 10-year predicted cardiovascular risk) associated with aspirin prescribing for primary and secondary cardiovascular prevention among adults aged ≥50 years in Ireland?
Cross-Sectional (n=6,618)
What are the prevalence and patient factors (including 10-year predicted cardiovascular risk) associated with aspirin prescribing for primary and secondary cardiovascular prevention among adults aged ≥50 years in Ireland?
Nearly four-fifths of Irish adults aged ≥50 years taking prescribed aspirin have no prior cardiovascular disease (representing ~201,000 adults nationally), highlighting substantial potentially inappropriate primary prevention use despite targeting of higher-risk individuals, alongside undertreatment in 16.5% of secondary prevention patients.
Answers are grounded in this paper and cite their sources.
High primary prevention aspirin use in Ireland may indicate overtreatment; leaves open whether risk-targeted prescribing improves net benefit in older adults.
Aspirin use for cardiovascular indications is widespread despite evidence not supporting use in patients without cardiovascular disease (CVD). This study characterises aspirin prescribing among people aged ≥50 years in Ireland for primary and secondary prevention, and factors associated with prescription. This cross-sectional study includes participants from wave 3 (2014-2015) of The Irish Longitudinal Study on Ageing. We identified participants reporting use of prescribed aspirin, other antiplatelets/anticoagulants, and doctor-diagnosed CVD (MI, angina, stroke, TIA) and other cardiovascular conditions. We examined factors associated with aspirin use for primary and secondary prevention in multivariate regression. For a subset, we also examined 10-year cardiovascular risk (using the Framingham general risk score) as a predictor of aspirin use. Among 6618 participants, the mean age was 66.9 years (SD 9.4) and 55.6% (3679) were female. Prescribed aspirin was reported by 1432 participants (21.6%), and 77.6% of aspirin users had no previous CVD. Among participants with previous CVD, 16.5% were not prescribed aspirin/another antithrombotic. This equates to 201,000 older adults nationally using aspirin for primary prevention, and 16,000 with previous CVD not prescribed an antithrombotic. Among those without CVD, older age, male sex, free health care, and more GP visits were associated with aspirin prescribing. Cardiovascular risk was significantly associated with aspirin use (adjusted relative risk 1.15, 95%CI 1.08-1.23, per 1% increase in cardiovascular risk). Almost four-fifths of people aged ≥50 years on aspirin have no previous CVD, equivalent to 201,000 adults nationally, however prescribing appears to target higher cardiovascular risk patients.
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Moriarty et al. (2021) conducted a cross-sectional in Primary and secondary prevention of cardiovascular disease (n=6,618). Predicted 10-year cardiovascular risk (per 1% increase in Framingham General Cardiovascular Risk score) vs. Lower cardiovascular risk was evaluated on Prescribed aspirin use for primary prevention (adjusted RR 1.15, 95% CI 1.08-1.23). Prescribed aspirin was reported by 21.6% of Irish adults aged >=50 years (77.6% for primary prevention), with each 1% increase in 10-year cardiovascular risk increasing use (aRR 1.15, 95% CI 1.08-1.23).
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