Low-Dose Aspirin for Primary Prevention of Cardiovascular Disease: Use Patterns and Impact Across Race and Ethnicity in the Southern Community Cohort Study

Abstract

Background Data are limited on use patterns of low-dose aspirin and its role for primary prevention of cardiovascular disease (CVD) in different racial and ethnic groups. Methods and Results Overall, 65 231 non-Hispanic black and white people aged 40 to 79 years with no history of CVD enrolled from 2002 through 2009 in the SCCS (Southern Community Cohort Study). At cohort entry, the simplified Framingham 10-year CVD risk was calculated, and data related to low-dose aspirin use and clinical and socioeconomic covariates were collected. Race- and ethnicity-specific adjusted odds ratios for characteristics of low-dose aspirin users and hazard ratios for ischemic cardiac death according to aspirin use were calculated using multivariate logistic and Cox regression models. Black participants were less likely to take low-dose aspirin compared with white participants, regardless of CVD risk and covariates (adjusted odds ratio: 0.79; 95% CI, 0.75-0.82). Over a median follow-up of 11.3 years, low-dose aspirin use was associated with a trend toward decreased risk of ischemic cardiac death in white participants (adjusted hazard ratio: 0.86; 95% CI, 0.68-1.10), especially in women (adjusted hazard ratio: 0.72; 95% CI, 0.51-1.02), but not in black participants (adjusted hazard ratio: 1.18; 95% CI, 0.98-1.40). Similar trends were observed when the analysis was restricted to high-risk individuals aged 50 to 69 or 50 to 59 years, ages for which guidelines consider aspirin for CVD primary prevention. Conclusions Low-dose aspirin use for primary prevention of CVD is lower among black than white patients. Its use might be associated with a disparate impact on ischemic cardiac death according to race and ethnicity. Although additional studies are required, these findings provide no evidence of a beneficial effect of aspirin among black patients for CVD primary prevention.

Keywords: aspirin; ethnicity; ischemic heart disease; primary prevention.

Figure 1

Study flow chart. A total of 65 231 SCCS (Southern Community Cohort Study) participants were included in this study. *Information of interest included vital status and the following variables obtained from the SCCS baseline questionnaire: year of SCCS enrollment, age at enrollment, sex, hypertension status, smoking status, diabetes mellitus status, body mass index, low‐dose aspirin use, race/ethnicity, household income, education, concomitant use of NSAIDs, and medical history of ulcer. CABG indicates coronary artery bypass grafting; CVD, cardiovascular disease; MI, myocardial infarction; TIA, transient ischemic attack.

Figure 2

Impact of race/ethnicity on low‐dose aspirin use in the high‐risk category. Forest plot summarizing adjusted odds ratio (95% CI) of low‐dose aspirin use in black and white participants according to selected variables among the SCCS (Southern Community Cohort Study) participants belonging to the Framingham 10‐year high‐risk category (≥10%) at enrollment. Results are derived from stratified multivariate logistic regression models. Models were adjusted for the following variables: year of SCCS enrollment, age at enrollment, sex, diabetes mellitus status, medical history of ulcer, concomitant use of NSAIDs, annual household income, and education.

Figure 3

Follow‐up of ischemic cardiac death according to low‐dose aspirin use in high‐risk participants. Race/ethnicity‐stratified Kaplan–Meier curves illustrating cumulative incidence of ischemic cardiac death during follow‐up according to low‐dose aspirin use. Results are presented for participants in the Framingham 10‐year high‐risk category (≥10%) aged 50 to 69 years or 50 to 59 years, for whom the use of low‐dose aspirin may be considered for the primary prevention of CVD according to the US Preventive Services Task Force 2016 recommendations.