JACC in a Flash | More than one in 10 patients in a large national registry, or about 11%, were being inappropriately advised to receive aspirin for the primary prevention of cardiovascular disease, according to the results of a study published in JACC.

Current guidelines recommend the use of aspirin for primary prevention in those patients with a 10-year cardiovascular disease risk of 6% or higher; however, according to data taken from the NCDR PINNACLE database, about one-tenth of patients receiving aspirin had a 10-year risk of less than 6%.

“Of note, there was a significant difference between practices above and below the median practice-level frequency of inappropriate aspirin use with respect to their duration of participation in the PINNACLE registry,” wrote Ravi S. Hira, MD, of Baylor College of Medicine, Houston, and colleagues. “This suggests a lack of audit and feedback to practices with higher inappropriate aspirin use.”

The researchers used the database to gather information on 68,808 patients who were receiving aspirin for the primary prevention of CVD. They sought to study inappropriate use of aspirin for primary prevention among those patients with a 10-year CVD risk of less than 6%.

The database identified 7,972 patients (11.6%) with a 10-year CVD risk of less than 6% who were receiving aspirin as primary prevention. The inappropriate use of aspirin was three times greater in women (16.6%) than in men (5.3%), but the inappropriate use of aspirin had declined from 14.5% in 2008 to 9.1% in 2013.

The researchers found a wide variation of inappropriate use among practices included in the study (0% to 71.8%; median of 10.1%).

“Interestingly, the patients receiving aspirin inappropriately were 16 years younger than those with appropriate use,” wrote Freek W.A. Verheught, MD, of Onze Lieve Vrouwe Gasthuis Radbound University Nijmegen Medical Center, in an accompanying editorial.

The average age of a patient inappropriately receiving aspirin was 59.9 years compared with 65.9 years among those with appropriate use.

In addition, Verheught also pointed out that the study was performed in cardiology practices compared with the majority of clinical trials evaluating aspirin for primary prevention, which have occurred in the general practice setting.

“Aspirin is effective in primary prevention of CVD, very likely also in the cardiology practice, but it is associated with excess extracranial bleeding, that irrespective the baseline risk seems to come close to its benefit,” Verheught wrote. “Thus, inappropriate use of aspirin should be avoided, especially in the younger patient population as demonstrated in Hira et al.’s study.”

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Hira RS, Virani SS, et al. J Am Coll Cardiol. 2015;(paper still in press as of printing).

Keywords: ACC Publications, CardioSource WorldNews

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