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Aspirin overutilization for the primary prevention of cardiovascular disease.

VanWormer JJ, Miller AW, Rezkalla SH - Clin Epidemiol (2014)

Bottom Line: A sensitivity analysis found a significant interaction between age and number of medical visits, indicating progressively more aspirin use in older age groups who visited their provider frequently.Obesity was the only significant clinical factor, suggesting misalignment between perceived aspirin benefits and cardiovascular risks in this subgroup of patients.Prospective studies that examine cardiac and bleeding events associated with regular aspirin use among obese samples (without CVD) are needed to refine clinical guidelines in this area.

View Article: PubMed Central - PubMed

Affiliation: Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Foundation, Marshfield, WI, USA.

ABSTRACT

Background: Aspirin is commonly used for the primary prevention of cardiovascular disease (CVD) in the US. Previous research has observed significant levels of inappropriate aspirin use for primary CVD prevention in some European populations, but the degree to which aspirin is overutilized in the US remains unknown. This study examined the association between regular aspirin use and demographic/clinical factors in a population-based sample of adults without a clinical indication for aspirin for primary prevention.

Methods: A cross-sectional analysis was performed using 2010-2012 data from individuals aged 30-79 years in the Marshfield Epidemiologic Study Area (WI, USA). Regular aspirin users included those who took aspirin at least every other day.

Results: There were 16,922 individuals who were not clinically indicated for aspirin therapy for primary CVD prevention. Of these, 19% were regular aspirin users. In the final adjusted model, participants who were older, male, lived in northern Wisconsin, had more frequent medical visits, and had greater body mass index had significantly higher odds of regular aspirin use (P<0.001 for all). Race/ethnicity, health insurance, smoking, blood pressure, and lipid levels had negligible influence on aspirin use. A sensitivity analysis found a significant interaction between age and number of medical visits, indicating progressively more aspirin use in older age groups who visited their provider frequently.

Conclusion: There was evidence of aspirin overutilization in this US population without CVD. Older age and more frequent provider visits were the strongest predictors of inappropriate aspirin use. Obesity was the only significant clinical factor, suggesting misalignment between perceived aspirin benefits and cardiovascular risks in this subgroup of patients. Prospective studies that examine cardiac and bleeding events associated with regular aspirin use among obese samples (without CVD) are needed to refine clinical guidelines in this area.

No MeSH data available.


Related in: MedlinePlus

Proportion of regular aspirin users among adults not clinically indicated for aspirin therapy for primary cardiovascular disease prevention.Notes: Based on a sensitivity analysis model stratified by age and number of ambulatory medical care encounters over the previous 3 years.Abbreviation: SE, standard error.
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f1-clep-6-433: Proportion of regular aspirin users among adults not clinically indicated for aspirin therapy for primary cardiovascular disease prevention.Notes: Based on a sensitivity analysis model stratified by age and number of ambulatory medical care encounters over the previous 3 years.Abbreviation: SE, standard error.

Mentions: Given the relatively large sample size, two follow-up sensitivity analyses were performed that tested 1) all possible two-way interaction terms (plus main effects) from the reduced model, and 2) a more conservative operational definition of nonregular aspirin users that excluded those individuals who used aspirin, but did so less frequently than daily or every other day. Full models are not shown from these sensitivity analyses, but as illustrated in Figure 1, there was one significant interaction observed between age and number of ambulatory care encounters (interaction, P=0.017; main effect for age, P<0.001; main effect for number of encounters, P=0.002), indicating a progressively greater proportion of regular aspirin users among older age groups who visited their provider more frequently. The second sensitivity analysis resulted in the exclusion of 64 individuals from the nonregular aspirin use group, with associations nearly identical to those observed in the main analysis.


Aspirin overutilization for the primary prevention of cardiovascular disease.

VanWormer JJ, Miller AW, Rezkalla SH - Clin Epidemiol (2014)

Proportion of regular aspirin users among adults not clinically indicated for aspirin therapy for primary cardiovascular disease prevention.Notes: Based on a sensitivity analysis model stratified by age and number of ambulatory medical care encounters over the previous 3 years.Abbreviation: SE, standard error.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4259866&req=5

f1-clep-6-433: Proportion of regular aspirin users among adults not clinically indicated for aspirin therapy for primary cardiovascular disease prevention.Notes: Based on a sensitivity analysis model stratified by age and number of ambulatory medical care encounters over the previous 3 years.Abbreviation: SE, standard error.
Mentions: Given the relatively large sample size, two follow-up sensitivity analyses were performed that tested 1) all possible two-way interaction terms (plus main effects) from the reduced model, and 2) a more conservative operational definition of nonregular aspirin users that excluded those individuals who used aspirin, but did so less frequently than daily or every other day. Full models are not shown from these sensitivity analyses, but as illustrated in Figure 1, there was one significant interaction observed between age and number of ambulatory care encounters (interaction, P=0.017; main effect for age, P<0.001; main effect for number of encounters, P=0.002), indicating a progressively greater proportion of regular aspirin users among older age groups who visited their provider more frequently. The second sensitivity analysis resulted in the exclusion of 64 individuals from the nonregular aspirin use group, with associations nearly identical to those observed in the main analysis.

Bottom Line: A sensitivity analysis found a significant interaction between age and number of medical visits, indicating progressively more aspirin use in older age groups who visited their provider frequently.Obesity was the only significant clinical factor, suggesting misalignment between perceived aspirin benefits and cardiovascular risks in this subgroup of patients.Prospective studies that examine cardiac and bleeding events associated with regular aspirin use among obese samples (without CVD) are needed to refine clinical guidelines in this area.

View Article: PubMed Central - PubMed

Affiliation: Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Foundation, Marshfield, WI, USA.

ABSTRACT

Background: Aspirin is commonly used for the primary prevention of cardiovascular disease (CVD) in the US. Previous research has observed significant levels of inappropriate aspirin use for primary CVD prevention in some European populations, but the degree to which aspirin is overutilized in the US remains unknown. This study examined the association between regular aspirin use and demographic/clinical factors in a population-based sample of adults without a clinical indication for aspirin for primary prevention.

Methods: A cross-sectional analysis was performed using 2010-2012 data from individuals aged 30-79 years in the Marshfield Epidemiologic Study Area (WI, USA). Regular aspirin users included those who took aspirin at least every other day.

Results: There were 16,922 individuals who were not clinically indicated for aspirin therapy for primary CVD prevention. Of these, 19% were regular aspirin users. In the final adjusted model, participants who were older, male, lived in northern Wisconsin, had more frequent medical visits, and had greater body mass index had significantly higher odds of regular aspirin use (P<0.001 for all). Race/ethnicity, health insurance, smoking, blood pressure, and lipid levels had negligible influence on aspirin use. A sensitivity analysis found a significant interaction between age and number of medical visits, indicating progressively more aspirin use in older age groups who visited their provider frequently.

Conclusion: There was evidence of aspirin overutilization in this US population without CVD. Older age and more frequent provider visits were the strongest predictors of inappropriate aspirin use. Obesity was the only significant clinical factor, suggesting misalignment between perceived aspirin benefits and cardiovascular risks in this subgroup of patients. Prospective studies that examine cardiac and bleeding events associated with regular aspirin use among obese samples (without CVD) are needed to refine clinical guidelines in this area.

No MeSH data available.


Related in: MedlinePlus