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 In 2009, the U.S. Preventive Services Task Force (USPSTF), a
government-backed panel of independent physicians, advised men ages
45 to 79 and women ages 55 to 79 to take aspirin to prevent heart
attack and stroke as long as they didn’t have bleeding disorders
that might make the drug unsafe.
To see whether people in that age range took the advice, researchers
examined data from 2007 to 2015 on aspirin use for almost 89,000 men
and women who didn’t have bleeding disorders or other medical
reasons to avoid this drug. Overall, only 43 percent of these adults
took aspirin during the study period.
Even after researchers looked at how many risk factors people had
for cardiovascular disease – such as high blood pressure, elevated
cholesterol and smoking – the 2009 recommendations didn’t appear to
boost aspirin use, researchers report in the Journal of the American
Heart Association.
After 2009, aspirin use declined from 45 percent to 40 percent among
people at low risk for heart attacks and strokes; from 66 percent to
62 percent among people at medium risk; and from 76 percent to 73
percent among high-risk individuals.
“There are many examples of preventive therapies that are
underutilized and are minimally affected by publication of
recommendation,” said lead study author Dr. Jeremy Van’t Hof of the
University of Minnesota in Minneapolis.
“The challenge with any therapy for prevention is the fact that you
are attempting to make a change in a patient who feels well with no
manifestation of disease,” Van’t Hof said by email. “It is much
easier to convince someone to treat a broken arm or a pneumonia
because they can see and feel the problem.”
Last year, the USPSTF updated its aspirin recommendations, advising
adults aged 50 to 59 who have at least a 10 percent risk of having a
heart attack or stroke in the next 10 years to take aspirin every
day.
The American College of Cardiology provides an online risk
calculator here: http://tools.acc.org/ASCVD-Risk-Estimator-Plus/.
The advice doesn’t apply to people in their 60s because the bleeding
risk increases with age, however, and the jury is still out on
whether this approach makes sense for people under 50 or over 70,
the Task Force concluded in its most recent recommendations.
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Many patients who haven’t had a heart attack or stroke will see a
primary care provider and not a cardiologist, and the new study
findings suggest that many of these patients aren’t getting the
message that they may benefit from aspirin, said Dr. Ying Xian, a
researcher at Duke University Medical Center in Durham, North
Carolina, who wasn’t involved in the study.
“What is surprising here is that many patients with intermediate
cardiovascular disease risk did not take aspirin for no apparent
reasons,” Xian said by email. “This represents a missed opportunity
for heart disease and stroke prevention.”
One limitation of the study, however, is that it looked at health
records from patients seen in primary care, which may not represent
all people at risk for cardiovascular disease or capture patients
who take aspirin without a prescription, Dr. Samuel Wann, a
researcher at Ascension Healthcare in Milwaukee who wasn’t involved
in the study, said by email.
Even so, the findings add to the evidence that aspirin is underused
as a tool to prevent heart disease, said Dr. Gregg Fonarow of the
David Geffen School of Medicine at the University of California, Los
Angeles.
“Prior studies have also shown that release of guidelines or
national recommendations alone is not sufficient to influence care
or treatment of patients,” Fonarow, who wasn’t involved in the
study, said by email. “To better ensure evidence-based,
guideline-recommended, well calibrated, aspirin use, performance
improvement systems need to be implemented in all care settings.”
SOURCE: http://bit.ly/2zlSHtx Journal of the American Heart
Association, online October 3, 2017.
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