Misuse of Aspirin and Associated Factors for the Primary Prevention of Cardiovascular Disease.

Yinong Chen,Luyao Yu,Chun Yin,Qing Li,Longyang Zhu,Dayi Hu,Yihong Sun

doi:10.3389/fcvm.2021.720113

Abstract

Background: The value of aspirin for primary prevention continues to be debated. Data showing whether aspirin use for primary prevention adheres to established guidelines in real world practice are sparse.Methods: A total of 13,104 patients without cardiovascular diseases (CVD) were selected from the DYS-lipidemia International Study of China, a national survey of patients with dyslipidemia in 2012. The CVD risk of the participants were calculated using the 10-year risk of Ischemic Cardiovascular Diseases model. The misuse of aspirin for primary prevention was defined as having CVD risk <10% with daily aspirin. Multivariate logistic regression models were used to explore risk factors associated with aspirin misuse.Results: The proportion of the patients categorized as low, moderate and high risk for CVD were 52.9, 21.6, and 25.4% respectively. The misuse frequency of aspirin was 31.0% (2,147/6,933) in patients with low risk. The misuse of aspirin increased with aging for both men and women. In the multivariate analysis, the independent risk factors associated with aspirin misuse were hypertension, diabetes mellitus, a family history of premature CVD, and elderly age. Level of total cholesterol is negatively associated with aspirin misuse. Patients from low level hospitals are more likely to be taking aspirin inappropriately. Results remained consistent after including 2,837 patients having 10-year risk for CVD between 10 and <20%.Conclusion: The misuse of aspirin for primary prevention is common in patients having CVD risk <10%. There are important opportunities to improve evidence-based aspirin use for the primary prevention of CVD in Chinese patients.Clinical Trial Registration:https://clinicaltrials.gov/, identifier [NCT01732952].

Highlights

Cardiovascular diseases (CVD) involving atherosclerosis are the leading cause of death both in China and all over the world [1]
The decision on whether a patient should take aspirin for primary prevention of CVD depends on a balance between CVD and bleeding risks, and this requires the assessment of CVD risk as a first step
We described the contemporary patterns of aspirin use for primary prevention for CVD in Chinese patients taking lipidlowering drugs and explored the risk factors associated with aspirin misuse

Summary

Introduction

Cardiovascular diseases (CVD) involving atherosclerosis are the leading cause of death both in China and all over the world [1]. Overuse of Aspirin in CVD prevention significantly reduced the risk of nonfatal myocardial infarction, but no significant reductions in nonfatal stroke, cardiovascular mortality or all-cause mortality, which is consistent with the former meta-analysis by Antithrombotic Trialists’ Collaboration [2, 3]. The most recent metaanalysis showed that aspirin for primary prevention reduces nonfatal ischemic events while significantly increases nonfatal bleeding events [4]. The American guideline did not recommend the use of aspirin in the primary prevention of CVD unless for those with high risk of CVD and no bleeding risk [6]. The value of aspirin for primary prevention continues to be debated. Data showing whether aspirin use for primary prevention adheres to established guidelines in real world practice are sparse

Methods

Results

Discussion

Conclusion