Aspirin Use Among Adults in the U.S.

Williams, Craig D.; Chan, Andrew T.; Elman, Miriam R.; Kristensen, Alyson H.; Miser, William F.; Pignone, Michael; Stafford, Randall S.; McGregor, Jessina C.

doi:10.1016/j.amepre.2014.11.005

Cited by 101 publications

(58 citation statements)

References 8 publications

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“…Although a statistically significant decrease, the clinical difference is small, reflecting a lack of major change in aspirin use behavior. A recent national survey described PP aspirin use in 47% of adults aged 45 to 75 years33 which is similar to the prevalence found in this study. The lack of improvement in PP aspirin use contrasts with the large increase in SP aspirin use observed in response to secondary CVD prevention guideline dissemination 30, 34, 35, 36.…”

Section: Discussionsupporting

confidence: 91%

“…While the accuracy of these data cannot be known, misclassification of low‐dose aspirin use in an EHR has been shown to be uncommon 45. Two studies evaluating PP aspirin use gathered data by surveying participants and reported aspirin use rates similar to those in our study 33, 46. As noted, this method of analysis does not allow for determination of the indication for aspirin use or how regularly it is used.…”

Section: Discussionmentioning

confidence: 82%

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Contemporary Primary Prevention Aspirin Use by Cardiovascular Disease Risk: Impact of US Preventive Services Task Force Recommendations, 2007—2015: A Serial, Cross‐sectional Study

Hof

Duval

Walts

et al. 2017

JAHA

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BackgroundNo previous study has evaluated the impact of past US Preventive Services Task Force statements on primary prevention (PP) aspirin use in a primary care setting. The aim of this study was to evaluate temporal changes in PP aspirin use in a primary care population, stratifying patients by their 10‐year global cardiovascular disease risk, in response to the 2009 statement.Methods and ResultsThis study estimated biannual aspirin use prevalence using electronic health record data from primary care clinics within the Fairview Health System (Minnesota) from 2007 to 2015. A total of 94 270 patient encounters had complete data to estimate a 10‐year cardiovascular disease risk score using the 2013 American College of Cardiology/American Heart Association global risk estimator. Patients were stratified into low‐ (<10%), intermediate‐ (10–20%), and high‐ (≥20%) risk groups. Over the 9‐year period, PP aspirin use averaged 43%. When stratified by low, intermediate and high risk, average PP aspirin use was 41%, 63%, and 73%, respectively. Average PP aspirin use decreased after the publication of the 2009 US Preventive Services Task Force recommendation statement: from 45% to 40% in the low‐risk group; from 66% to 62% in the intermediate‐risk group; and from 76% to 73% in the high‐risk group, before and after the guideline.ConclusionsPublication of the 2009 US Preventive Services Task Force recommendation was not associated with an increase in aspirin use. High risk PP patients utilized aspirin at high rates. Patients at intermediate risk were less intensively treated, and patients at low risk used aspirin at relatively high rates. These data may inform future aspirin guideline dissemination.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 82%

Contemporary Primary Prevention Aspirin Use by Cardiovascular Disease Risk: Impact of US Preventive Services Task Force Recommendations, 2007—2015: A Serial, Cross‐sectional Study

Hof

Duval

Walts

et al. 2017

JAHA

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“…Second, aspirin exposure, a potential risk factor for GI bleeding/PUD, was not fully classifiable due to over-the-counter use. A recent US nationwide survey of adults (aged 45–75 years) found that 52% reported daily aspirin use; 47% among 2039 respondents without a history of cardiovascular disease[27]. While higher doses of aspirin and aspirin-containing medications that would require a prescription are captured in this study, GI consequences of chronic low doses (not captured in this study) cannot be ruled out and remain as missing information.…”

Section: Discussionmentioning

confidence: 98%

Prevalence of and risk for gastrointestinal bleeding and peptic ulcerative disorders in a cohort of HIV patients from a U.S. healthcare claims database

2017

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The primary study objectives were to estimate the frequencies and rates of gastrointestinal bleeding and peptic ulcerative disorder in HIV-positive patients compared with age- and sex-matched HIV-negative subjects. Data from a US insurance claims database was used for this analysis. Among 89,207 patients with HIV, 9.0% had a GI bleed, 1.0% had an upper gastrointestinal bleed, 5.6% had a lower gastrointestinal bleed, 1.9% had a peptic ulcerative disorder diagnosis, and 0.6% had both gastrointestinal/peptic ulcerative disorder. Among 267,615 HIV-negative subjects, the respective frequencies were 6.9%, 0.6%, 4.3%, 1.4%, and 0.4% (p<0.0001 for each diagnosis subcategory). After combining effect measure modifiers into comedication and comorbidity strata, gastrointestinal bleeding hazard ratios (HRs) were higher for HIV-positive patients without comedication/comorbidity, and those with comedication alone (HR, 2.73; 95% confidence interval [CI], 2.62–2.84; HR, 1.59; 95% CI, 1.47–1.71). The rate of peptic ulcerative disorder among those without a history of ulcers and no comorbidity/comedication was also elevated (HR, 2.72; 95% CI, 2.48–2.99). Hazard ratios of gastrointestinal bleeding, and peptic ulcerative disorder without a history of ulcers were lower among patients infected with HIV with comedication/comorbidity (HR, 0.64; 95% CI, 0.56–0.73; HR, 0.46; 95% CI, 0.33–0.65). Rates of gastrointestinal bleeding plus peptic ulcerative disorder followed a similar pattern. In summary, the rates of gastrointestinal/peptic ulcerative disorder events comparing HIV-infected subjects to non–HIV-infected subjects were differential based on comorbidity and comedication status.

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“…The role of aspirin in primary prevention of CVD is less defined and is currently under further investigation [44,54,60–64]. Nevertheless, it is widely used by older adults, with 20%–50% of older persons in the USA, without cardiovascular disease, being regular users of aspirin [65,66]. The role of low dose aspirin in cancer prevention and management is also under investigation [65,67–70].…”

Section: Discussionmentioning

confidence: 99%

Age-related macular degeneration in a randomized controlled trial of low-dose aspirin: Rationale and study design of the ASPREE-AMD study

Robman

Guymer

Woods

et al. 2017

Contemporary Clinical Trials Communications

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Purpose Although aspirin therapy is used widely in older adults for prevention of cardiovascular disease, its impact on the incidence, progression and severity of age-related macular degeneration (AMD) is uncertain. The effect of low-dose aspirin on the course of AMD will be evaluated in this clinical trial. Design A sub-study of the ‘ASPirin in Reducing Events in the Elderly’ (ASPREE) trial, ASPREE-AMD is a 5-year follow-up double-blind, placebo-controlled, randomized trial of the effect of 100 mg daily aspirin on the course of AMD in 5000 subjects aged 70 years or older, with normal cognitive function and without cardiovascular disease at baseline. Non-mydriatic fundus photography will be performed at baseline, 3-year and 5-year follow-up to determine AMD status. Primary outcome measures The incidence and progression of AMD. Exploratory analyses will determine whether aspirin affects the risk of retinal hemorrhage in late AMD, and whether other factors, such as genotype, systemic disease, inflammatory biomarkers, influence the effect of aspirin on AMD. Conclusion The study findings will be of significant clinical and public interest due to a potential to identify a possible low cost therapy for preventing AMD worldwide and to determine risk/benefit balance of the aspirin usage by the AMD-affected elderly. The ASPREE-AMD study provides a unique opportunity to determine the effect of aspirin on AMD incidence and progression, by adding retinal imaging to an ongoing, large-scale primary prevention randomized clinical trial.

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Aspirin Use Among Adults in the U.S.

Cited by 101 publications

References 8 publications

Contemporary Primary Prevention Aspirin Use by Cardiovascular Disease Risk: Impact of US Preventive Services Task Force Recommendations, 2007—2015: A Serial, Cross‐sectional Study

Contemporary Primary Prevention Aspirin Use by Cardiovascular Disease Risk: Impact of US Preventive Services Task Force Recommendations, 2007—2015: A Serial, Cross‐sectional Study

Prevalence of and risk for gastrointestinal bleeding and peptic ulcerative disorders in a cohort of HIV patients from a U.S. healthcare claims database

Age-related macular degeneration in a randomized controlled trial of low-dose aspirin: Rationale and study design of the ASPREE-AMD study

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