Older Adults with Diabetes Twice as Likely to Use Aspirin for Prevention

A new investigation by a team at Johns Hopkins is highlighting the need for reeducation on the topic of preventive aspirin use among older patients with diabetes.

A cross-sectional study of more than 7000 patients, results indicate rates of preventive aspirin use were doubled among older adults with diabetes compared to those without diabetes and also suggests continued use may not be recommended for a large number of these patients based on new guidance.

“The prevalence of aspirin use among older US adults is high among populations at an increased risk for harm, particularly older individuals and individuals with diabetes, who already are at an increased bleeding risk compared with those without diabetes,” wrote investigators. “These findings suggest a greater need for health care providers to ask their older patients about aspirin use and, given recent guideline changes, to discuss the risks and benefits of continuing aspirin treatment for CVD prevention.”

With recent research debunking many previous ideas related to appropriateness of aspirin use for prevention of cardiovascular disease in older adults, investigators sought to assess current prevalence of use for primary and secondary prevention among patients with diabetes versus those without diabetes. To do so, the team designed the current analysis as a cross-sectional study using data recorded between 2011-2018 within the National Health and Nutrition Examination Survey (NHANES).

Using the aforementioned time frame as the study period, investigators identified a total of 37,399 patients who participated in both the interview and physical examination portion of NHANES. Among this group, 7299 were aged 60 years or older. After exclusion of those with missing information, 7103 patients were identified for inclusion in the final study cohort. This cohort had a mean age of 69.6 (SD, 0.1) years, 45.2% were men, and 75.8% were White.

Overall, 61.7% of older adults with diabetes and 42.2% of older adults without diabetes reported aspirin use. In adjusted logistic models, results indicated prevalence of use did not differ based on age of patients among older patients with diabetes. In contrast, results indicated aspirin use was significantly greater among those in older age categories compared to those 60-69 years of age (70-79 years: OR, 1.50 [95% CI, 1.23-1.83]; 80-89 years: OR, 1.59; 95% CI, 1.24-2.04).

Further analysis suggested the likelihood of aspirin use for primary prevention in those at high vs low risk for cardiovascular did not different among adults with diabetes (OR, 1.69; 95% CI, 0.65-4.39) but was significantly greater in those without diabetes (OR, 2.46; 95% CI, 1.63-3.71). Additionally, women with diabetes were less likely than men with diabetes to be using aspirin for primary prevention (OR, 0.63; 95% CI, 0.48-0.83).

“Future studies should examine the influence of updating guidelines on clinician behaviors and the association of changing trends in preventive aspirin use with the development of CVD in older adults,” wrote investigators.

This study, “Use of Preventive Aspirin Among Older US Adults With and Without Diabetes,” was published in JAMA Network Open.