Evidence supporting aspirin therapy’s ability to lower the risk of adverse cardiovascular events in patients without cardiovascular disease is flimsy at best, but the medication is often linked to a risk for gastrointestinal bleeding and hemorrhagic strokes. In other words, the risks tend to outweigh the benefits. A recent study published in the Journal of the American College of Cardiology has found that over 10 percent of patients who are treated with aspirin therapy to prevent the development of heart disease are likely inappropriately prescribed the medication.

"Medical providers must consider whether the potential for bleeding [outweighs] the potential benefits of aspirin therapy in patients who don't yet meet the guidelines for prescribing aspirin therapy," Dr. Ravi S. Hira and Dr. Salim S. Virani, lead researchers from the Baylor College of Medicine in Houston, said in a statement. "Since aspirin is available over the counter, patient and public education against using aspirin without a medical provider's recommendation will also play a key role in avoiding inappropriate use."

Hira, Virani, and their colleagues assessed data from a national sample of 68,808 patients who were receiving aspirin therapy for primary cardiovascular disease prevention. Data was gathered using the National Cardiovascular Disease Registry Practice Innovation and Clinical Excellence (PINNACLE) Registry. Patients from 119 practices who were prescribed aspirin between January 2008 and June 2013 were identified after researchers excluded those who received the medication as a secondary prevention due to a history of heart disease, including myocardial infarction, previous stroke, and atrial fibrillation.

Using aspirin guidelines issued by the American Heart Association, the U.S. Preventative Services Task Force, and other organizations, it was determined that patients with a 10-year cardiovascular disease risk of less than six percent should not be prescribed aspirin therapy. Findings from the study revealed that 12 percent of the patients who were prescribed aspirin for primary cardiovascular disease prevention received it inappropriately. More women and younger patients received aspirin therapy inappropriately compared to men and patients 16 years older.

"Major coronary events are reduced 18 percent by aspirin, but at the cost of an increase of 54 percent of major extracranial bleeding," Dr. Freek W.A. Verheugt, from Onza Lieve Vrouwe Gasthuis Radboud University Nijmegen Medical Centre in Amsterdam, said in an accompanying editorial. "Each two major coronary events have shown to be prevented by prophylactic aspirin at the cost of one major extracranial bleed. Yet, primary prevention with aspirin is widely applied."

According to the American Heart Association, patients at risk for a heart attack should consider taking a daily low-dose aspirin after consulting their physician and heart attack survivors should regularly take low-dose aspirin. Patients should always consult their physician before starting aspirin therapy, since the risks and benefits often vary for each patient. The Food and Drug Administration recently denied a request to market aspirin as a treatment for primary heart disease patient. Results of this new study also found that inappropriate aspirin prescriptions declined from 14 percent in 2008 to nine percent in 2013.

Source: Kennedy K, Hira R, Virani S, et al. Frequency and Practice-Level Variation in Inappropriate Aspirin Use for the Primary Prevention of Cardiovascular Disease. Journal of the American College of Cardiology. 2015.