Abstract 13669: Secondary Prevention Aspirin Trends in the Upper Midwest, 2015-2019

Abstract

Introduction: Secondary prevention (SP) aspirin use after a cardiovascular disease (CVD) event is strongly recommended and supported by consistent guidelines. Aspirin recommendations for primary prevention have varied over time, recently becoming more restrictive after clinical trials published in 2018. Hypothesis: Negative scientific and media attention regarding primary prevention aspirin would result in unintentional decline in SP aspirin use. Methods: We conducted random telephone surveys of adults aged 45-79 years in the upper Midwest in 2015, 2017, and 2019. We queried participant demographics, CVD history and risk factors and aspirin use. Using logistic regression, we evaluated i) the trend in SP aspirin use over the 3 surveys and ii) characteristics associated with SP aspirin non-use, adjusting for other antithrombotic use. Results: A total of 1907 adults with history of CVD provided data for analysis, median age 70 years, 38% female. There was no significant change in SP aspirin use in the total sample, nor by age, sex, or CVD risk factors. SP aspirin use was significantly lower among participants with 0-1 CVD risk factors compared with those diagnosed with ≥2 (Figure). Younger participants also used aspirin less frequently (67% for <60 years vs 76% for 60+ years). Respondents who talked with their healthcare provider about aspirin had much higher aspirin use than those who did not (87% vs 60%). In the 2019 survey, 11% of participants stopped aspirin. Stoppers were more likely to be on another antithrombotic medication (61% vs 43%) and less likely to have the diagnosis of hypertension (78% vs 81%) or hyperlipidemia (68% vs 72%) compared with those on aspirin. Stoppers also had fewer aspirin discussions with their provider (45% vs 69%). Conclusions: It is reassuring that SP aspirin use did not drop during a time of negative messaging for primary prevention aspirin. Unfortunately, underuse remains evident in younger adults and those with fewer CVD risk factors.