Aspirin and Statin Use for Primary Prevention of Cardiovascular Disease
Abstract
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the United States and aspirin and statins are well-known medications associated with CVD prevention. There are well-known benefits of aspirin for secondary prevention of CVD, but aspirin’s role in primary prevention remains controversial. The decision to start aspirin for primary prevention is individualized to the specific patient and situation. Statins are a drug used as first-line therapy in cholesterol management, though there is a complicated relationship with adherence due to real and/or perceived safety issues associated with statin use. The decision to start statins needs to be determined on an individualized basis.
The United States Preventive Services Task Force (USPSTF) has level B recommendations for low-dose aspirin (81 mg) and level B recommendation for statins in primary prevention of CVD. However, preliminarily updated recommendations for aspirin use in late 2021 are proposing the decision to change aspirin use to a level C recommendation. In addition, the American Heart Association (AHA) and American College of Cardiology (ACC) developed a calculator in 2013 to determine a patient’s 10-year CVD risk. The guidelines coupled with the risk calculator offers providers a valuable decision-making tool. However, despite available guidelines and the calculator, aspirin and statin prescription and adherence remains suboptimal.
The purpose of the project was successful adoption of the 2016 USPSTF guideline on aspirin and statin use for primary prevention of CVD by North Dakota State University (NDSU) staff participating in a NDSU Health Screening. The screening collected participant data, recorded data into the calculator, and provided recommendations based off the USPSTF guidelines for participants to discuss with their primary care provider (PCP).
Evaluations were performed through use of post-implementation surveys. Results demonstrated proper participant use of aspirin and statins according to USPSTF guidelines, with a majority expressing awareness of the guidelines. Participants reported a positive viewpoint of the calculator and intent to provide results to their PCP. Conclusively, the project supports use of the 2016 USPSTF guidelines regarding the use of aspirin and statins for primary prevention of CVD along with the risk calculator in health screenings and primary care.