Use of aspirin for primary and secondary cardiovascular disease prevention in the United States, 2011-2012

Background: Aspirin use has been shown to be an effective tool in cardiovascular disease (CVD) prevention among high-risk patients. The patient-reported physician recommendation for aspirin as preventive therapy among high- and low-risk patients is unknown.

Methods and results: We conducted an analysis of the National Health and Nutrition Examination Survey 2011-2012 to examine the use of aspirin for CVD prevention. Patients without previously diagnosed CVD were classified into high and low risk based on their Framingham Risk Score (10-year coronary heart disease risk). Among patients without previously diagnosed CVD, 22.5% were classified as high risk. Of the high-risk individuals, 40.9% reported being told by their physician to take aspirin, with 79.0% complying. Among those who were at low risk, 26.0% were told by their physician to take aspirin, with 76.5% complying. Logistic regression analysis indicated that age, access to a regular source of care, education, and insurance status were significant predictors of patient-reported physician recommendations for aspirin use for primary prevention. Among high-risk patients, age, race, and insurance status were significant predictors of reported recommendations for aspirin use. Among low-risk patients, age, education, obesity, and insurance status were significant predictors of reported recommendations for aspirin use.

Conclusions: Patient reports indicate nonideal rates of being told to take aspirin, for both high- and low-risk patients for primary prevention. Clinical decision support tools that could assist physicians in identifying patients at risk may increase patient reports of physician recommendations for aspirin use.