US POPULATION QUALIFYING FOR ASPIRIN USE FOR PRIMARY PREVENTION OF CARDIOVASCULAR DISEASE:

Abstract

Therapeutic Area: CVD Prevention – Primary and Secondary Background: Aspirin for the primary prevention of cardiovascular disease (CVD) remains controversial. The 2022 US Preventive Services Task Force (USPSTF) guidelines give a grade C recommendation to consider aspirin use for primary prevention in adults aged 40-59 years with a 10-year ASCVD risk ≥10% and not at increased risk of bleeding. We sought to determine the prevalence and demographics of the US adult population who meet eligibility criteria under these guidelines. Methods: Adults from the 2011-2018 National Health and Nutrition Examination Survey (NHANES) database aged ≥18 years without a self-reported history of CVD and with a 10-year ASCVD risk ≥10% calculated by the Pooled Cohort Equations were included. Increased bleeding risk variables were selected per the USPSTF modeling criteria and adapted to available NHANES variables, including congestive heart failure, atrial fibrillation, chronic or diabetic kidney disease, peptic ulcer disease, bleeding history, thrombocytopenia, and use of anticoagulation, corticosteroids, selective serotonin reuptake inhibitors, NSAID drugs, or other antiplatelet agents. The weighted frequencies of US adults aged 40-59 and ≥18 years who qualify for primary prevention aspirin were calculated. Results: The study sample included 6730 individuals aged 40-59 years, representing 80 million people in the US population. A total of 7.8 million individuals in this age group are eligible for consideration of aspirin use for primary prevention, with approximately 30% meeting criteria for increased bleeding risk. This results in a net eligible cohort of 5.4 million individuals, representing 6.8% of adults aged 40-59 years. Male sex, age 50-59 years, and Black race have higher proportions meeting aspirin use eligibility and increased bleeding risk. Notably, only 2.1% of women in this age group are aspirin eligible. Among the entire US adult population ≥18 years, 2.5% are eligible under these guidelines. Conclusions: The prevalence of US individuals who qualify for aspirin use for the primary prevention of CVD under the 2022 USPSTF guidelines is small, with larger proportional eligibility among men, older age, and Black individuals. These findings suggest that the clinical application of aspirin for primary prevention in the modern era using traditional eligibility criteria under USPSTF recommendations remains limited.