New Study Suggests Many Middle-Aged Adults May Not Need Aspirin
Recent research from Rochester General Hospital, the University of Texas Southwestern Medical Center, and Aga Khan University indicates that a significant proportion of middle-aged adults may be using aspirin unnecessarily for heart disease prevention. By employing updated cardiovascular risk assessment equations, the study suggests a reevaluation of aspirin candidacy in this demographic.
Aspirin is commonly prescribed due to its potential to lower the risk of cardiovascular events; however, it also poses a risk of major bleeding. Current guidelines from the U.S. Preventive Services Task Force recommend aspirin for adults aged 40 to 59 who have a 10-year cardiovascular risk of at least 10% and are not at high risk for bleeding.
The researchers introduced a new set of equations, called the Predicting Risk of Cardiovascular Disease EVENTs (PREVENT), which aim to provide more accurate risk assessments compared to traditional pooled cohort equations. The implications of these new equations on aspirin use had not been previously investigated.
In the study published in JAMA Internal Medicine, the team analyzed data from 3,158 participants in the National Health and Nutrition Examination Survey, representing an estimated 59.4 million U.S. adults aged 40 to 59 who do not have cardiovascular disease. Participants with conditions that increase bleeding risk, such as severe kidney disease, low platelet counts, or those on certain medications, were excluded from the analysis.
The research evaluated aspirin eligibility by calculating 10-year cardiovascular risks using both the pooled cohort and PREVENT equations. Aspirin candidacy was defined as having a risk of 10% or higher. The findings revealed that only 8.3% of middle-aged adults qualified for aspirin use under the pooled cohort equations, equating to approximately 4.9 million individuals. In stark contrast, only 1.2% (around 700,000 individuals) were deemed eligible under the PREVENT criteria.
Among the adults who met the pooled cohort criteria, a substantial 85.9% did not qualify under the PREVENT equation. Furthermore, of the estimated 7.6 million adults who reported taking aspirin for prevention, nearly 97% did not meet the eligibility criteria established by PREVENT.
The authors of the study emphasize the need to reconsider the 10% risk threshold that is currently applied, suggesting that specific thresholds based on the PREVENT equations may need to be established. This will likely involve further modeling studies to accurately determine the net benefits of aspirin use.
The research highlights a significant opportunity to reduce unnecessary aspirin use among adults who are unlikely to benefit from it. This finding could lead to changes in clinical practice and guidelines, ultimately affecting millions of individuals who currently take aspirin without a clear indication.