scholarly journals Trajectories of Adherence to Low-Dose Aspirin Treatment Among the French Population

2019 ◽  
Vol 25 (1) ◽  
pp. 37-46 ◽  
Author(s):  
Aya Ajrouche ◽  
Candice Estellat ◽  
Yann De Rycke ◽  
Florence Tubach
Keyword(s):  
Low Socioeconomic Status ◽  
Index Date ◽  
Low Dose ◽  
French Population ◽  
Low Socioeconomic ◽  
National Health Care ◽  
Dose Aspirin ◽  
Low Dose Aspirin ◽  
Health Care Database

Background: Previous studies have shown that adherence to low-dose aspirin (LDA) is suboptimal. However, these studies were based on an average measure of adherence during follow-up, ignoring its dynamic process over time. We described the trajectories of adherence to LDA treatment among the French population over 3 years of follow-up. Methods: We identified a cohort of 11 793 new LDA users, aged ≥50 years in 2010, by using the French national health-care database. Patients included had at least 3 years of history in the database before study entry to exclude prevalent aspirin users and to assess baseline comorbidities. They were followed from the first date of LDA supply (the index date) until the first date among death, exit from the database, or 3 years after the index date. Adherence to LDA was assessed every 3 months by using the proportion of days covered (PDC) and dichotomized with a cutoff of PDC of 0.8. We used group-based trajectory modeling to identify trajectories of LDA adherence. Predictors of LDA adherence trajectory membership were identified by multinomial logistics regression. Results: We identified 4 trajectories of adherence among new LDA users: the not-adherents (4737 [40.2%]), the delayed not-adherents (gradual decrease in adherence probability, 1601 [13.6%]), the delayed adherents (gradual increase in adherence probability, 1137 [9.6%]), and the persistent adherents (4318 [36.6%]). The probability of belonging to the not-adherent group was increased with female sex, low socioeconomic status, and polymedication and was reduced with a secondary indication for LDA use, such as diabetes, hypertension, and dementia, at least 4 consultations in the previous year, or 1 hospitalization or a cardiologist consultation in the 3 months before the index date. Conclusion: This study provides a dynamic picture of adherence behaviors among new LDA users and underlines the presence of critical trajectories that intervention could target to improve adherence.

Long-term persistence to low-dose aspirin for cardiovascular prevention in routine clinical practice in United Kingdom and Germany

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Vora ◽  
M Soriano-Gabarro ◽  
B Russell ◽  
H Morgan Stewart
Keyword(s):  
Index Date ◽  
Low Dose ◽  
Aspirin Therapy ◽  
Routine Clinical Practice ◽  
Vascular Events ◽  
Dose Aspirin ◽  
Low Dose Aspirin ◽  
Cvd Prevention

Abstract Background Low-dose aspirin is effective in the prevention of ischemic vascular events and studies have shown a preventative effect on colorectal cancer (CRC). Discontinuation of low-dose aspirin is associated with increased risk of ischaemic vascular events. However, data on long-term persistence to low-dose aspirin from routine clinical practice are limited. Purpose To assess the long-term persistence to low-dose aspirin therapy in the primary and secondary cardiovascular (CVD) prevention population Methods This retrospective cohort study used data from United Kingdom (UK) – The Health Improvement Network database and Germany (DE) – IQVIA Disease Analyzer and analyzed using an adaptation of Observational Health Data Sciences and Informatics (OHDSI) ATLAS Tool. Patients 18 years or older, with at least two prescriptions of low-dose aspirin (75–100mg) within the first year of index date during the study period between 2007 and 2018, and with at least 12 months of observation before and after the index date were included in the study. The patients with a CVD diagnosis or a CABG/PCI procedure before the index date or a prescription of dual antiplatelet at index date were classified as secondary CVD prevention. The remaining patients were classified as potential primary CVD prevention. The index date was first prescription of low-dose aspirin. Persistence was calculated if the gap between two prescriptions exceeds 60 days. Patients with such gaps still receiving prescription after 60 days were plotted based on the number of gaps identified during the follow-up and if no prescription was recorded then they were considered discontinued. Results The total number of patients receiving low-dose aspirin was 327,806 (183,089 in UK and 144,717 in DE with up to 10 years of follow-up). A total of 112,887 and 101,704 received low-dose aspirin for secondary CVD prevention; 70,202 and 43,013 potentially for primary CVD prevention in UK and DE, respectively. Persistence at two years with a few gaps was 67% and 59% in UK and DE for secondary CVD prevention; 57% and 53% for primary CVD prevention, respectively. With multiple Gaps, 50% and 36% still receive prescription low-dose aspirin for 10 years in UK and DE, respectively for secondary CVD prevention. For Primary prevention, 36% and 32% receive prescription of aspirin for 10 years with multiple gaps in UK and DE (Figure). Conclusion After the initial drop in persistence the patients tend to continue their low-dose aspirin treatment for long-term, although with multiple gaps. Overall, the persistence was higher in secondary compared to primary CVD prevention. Improving persistence to low-dose aspirin therapy in the initial years may help in continuity of their treatment over long-term. Persistence might be underestimated due to potential over the counter use of low-dose aspirin. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Bayer AG

Long-term adherence to low-dose aspirin therapy for cardiovascular prevention in routine clinical practice in United Kingdom and Germany

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Vora ◽  
M Soriano-Gabarro ◽  
B Russel ◽  
H Morgan Stewart
Keyword(s):  
United Kingdom ◽  
Index Date ◽  
Low Dose ◽  
Aspirin Therapy ◽  
Funding Source ◽  
Dose Aspirin ◽  
Low Dose Aspirin ◽  
Cvd Prevention

Abstract Background Low-dose aspirin is effective in the prevention of ischemic vascular events and studies have shown a preventative effect on colorectal cancer (CRC). However, adherence to therapy is likely an important factor for these benefits to be seen and non-adherence is associated with sub-optimal outcomes. Purpose To assess the long-term adherence to low-dose aspirin therapy in the primary and secondary cardiovascular (CVD) prevention population Methods This retrospective cohort study used data from United Kingdom (UK) – The Health Improvement Network Database and Germany (DE) – IQVIA Disease Analyzer and analyzed using an adaptation of Observational Health Data Sciences and Informatics (OHDSI) ATLAS Tool. Patients 18 years or older, with at least two prescriptions of low-dose aspirin (75–100mg) within the first year of index date during the study period between 2007 and 2018, and with at least 12 months of observation before and after the index date were included in the study. The patients with a CVD diagnosis or a CABG/PCI procedure before the index date or a prescription of dual antiplatelet at index date were classified as secondary CVD prevention. The remaining patients were classified as potential primary CVD prevention. The index date was first prescription of low-dose aspirin. Adherence was calculated using medication possession ratio (MPR) which is number of days of medication supplied within the refill interval divided by number of days in the refill interval. Long term adherence was divided in three categories namely patients with ≤2 years, 2-≤5 years, and 5-≤10 years of follow-up. Results The total number of patients receiving low-dose aspirin was 327,806 (183,089 in UK and 144,717 in DE with up to 10 years of follow-up). A total of 112,887 and 101,704 received low-dose aspirin for secondary CVD prevention; 70,202 and 43,013 potentially for primary CVD prevention in UK and DE, respectively. Median adherence to low-dose aspirin in UK and DE for patients with ≤2 years of follow-up was 88% and 80% for secondary CVD prevention, respectively; 84% and 74% for 2-≤5 years; and 75% and 59% for 5-≤10 years, respectively. Median adherence to low-dose aspirin in UK and DE for patients with ≤2 years was 76% and 75% for potential primary CVD prevention; 65% and 66% for 2-≤5 years; 49% and 49% for 5-≤10 years, respectively (Figure). Conclusion The long-term adherence to low dose aspirin was quite high with more than half the patients being adherent to their treatment. Overall, the adherence was higher in secondary compared to primary CVD prevention. The estimates for adherence might be underestimated due to potential over the counter use of low-dose aspirin. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Bayer AG

scholarly journals Sex Difference in Effects of Low-Dose Aspirin on Prevention of Dementia in Patients With Type 2 Diabetes: A Long-term Follow-up Study of a Randomized Clinical Trial

Diabetes Care ◽  
2019 ◽  
Vol 43 (2) ◽  
pp. 314-320 ◽  
Author(s):  
Chisa Matsumoto ◽  
Hisao Ogawa ◽  
Yoshihiko Saito ◽  
Sadanori Okada ◽  
Hirofumi Soejima ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Clinical Trial ◽  
Low Dose ◽  
Follow Up Study ◽  
Dose Aspirin ◽  
Low Dose Aspirin ◽  
Long Term Follow Up

scholarly journals Alternate-Day, Low-Dose Aspirin and Cancer Risk: Long-Term Observational Follow-up of a Randomized Trial

2013 ◽  
Vol 159 (2) ◽  
pp. 77 ◽  
Author(s):  
Nancy R. Cook ◽  
I-Min Lee ◽  
Shumin M. Zhang ◽  
M. Vinayaga Moorthy ◽  
Julie E. Buring
Keyword(s):  
Cancer Risk ◽  
Randomized Trial ◽  
Low Dose ◽  
Dose Aspirin ◽  
Low Dose Aspirin

scholarly journals Low-Dose Aspirin and Sporadic Anovulation in the EAGeR Randomized Trial

2016 ◽  
Vol 102 (1) ◽  
pp. 86-92 ◽  
Author(s):  
Rose G. Radin ◽  
Lindsey A. Sjaarda ◽  
Neil J. Perkins ◽  
Robert M. Silver ◽  
Zhen Chen ◽  
...  
Keyword(s):  
Pregnancy Loss ◽  
Low Dose ◽  
Controlled Trial ◽  
Double Blind ◽  
Menstrual Cycles ◽  
Spot Urine ◽  
Dose Aspirin ◽  
Low Dose Aspirin ◽  
History Of

Abstract Context: Among women with a single, recent pregnancy loss, daily preconception low-dose aspirin (LDA) increased the live birth rate with no effect on pregnancy loss. Ovulation is a potential mechanism underlying this effect. Objective: We estimated the effect of LDA on the per-cycle risk of anovulation among eumenorrheic women. Design: Multicenter, randomized, double-blind, placebo-controlled trial of daily LDA on reproductive outcomes. Preconception follow-up lasted 1 to 6 menstrual cycles (ClinicalTrials.gov, NCT00467363). Setting: Four US medical centers during 2007 to 2011. Patients or Other Participants: Healthy women (n = 1214), age 18 to 40, were attempting pregnancy, had regular menstrual cycles (21 to 42 days), and had a history of 1 to 2 documented pregnancy losses, ≤2 live births, and no infertility. All participants completed at least 1 menstrual cycle of follow-up; none withdrew due to adverse events. Intervention: Aspirin (81 mg) daily for 1 to 6 menstrual cycles. Main Outcome Measure: Per-cycle risk of anovulation, defined as the absence of both a positive spot-urine pregnancy test and a luteinizing hormone (LH) peak (2.5-fold increase in daily urinary LH). Hypothesis formulation preceded data collection. Results: Among 4340 cycles, LDA was not associated with anovulation (LDA: 13.4%, placebo: 11.1%; risk ratio = 1.16, 95% confidence interval, 0.88 to 1.52). Results were similar among women with a single, recent loss. Conclusions: Daily LDA had no effect on anovulation among women with a history of 1 to 2 pregnancy losses. LDA may affect fertility via other pathways, and these warrant further study.

scholarly journals Randomized placebo-controlled trial of the effects of aspirin on dementia and cognitive decline

Neurology ◽  
2020 ◽  
Vol 95 (3) ◽  
pp. e320-e331 ◽  
Author(s):  
Joanne Ryan ◽  
Elsdon Storey ◽  
Anne M. Murray ◽  
Robyn L. Woods ◽  
Rory Wolfe ◽  
...  
Keyword(s):  
Cognitive Decline ◽  
Low Dose ◽  
Controlled Trial ◽  
Verbal Learning ◽  
Cognitive Change ◽  
Community Dwelling ◽  
Older Individuals ◽  
Dose Aspirin ◽  
Low Dose Aspirin

ObjectiveTo determine the effect of low-dose aspirin vs placebo on incident all-cause dementia, incident Alzheimer disease (AD), mild cognitive impairment (MCI), and cognitive decline in older individuals.MethodsAspirin in Reducing Events in the Elderly (ASPREE) was a double-blind, placebo-controlled trial of low-dose aspirin. In the United States and Australia, community-dwelling individuals aged ≥70 years (US minorities ≥65 years) and free of cardiovascular disease, physical disability, and diagnosed dementia were enrolled. Participants were randomized 1:1–100 mg daily aspirin or placebo. The Modified Mini-Mental State Examination, Hopkins Verbal Learning Test–Revised, Symbol Digit Modalities Test, and Controlled Oral Word Association Test assessed cognition at baseline and over follow-up. Additional cognitive testing was performed in participants with suspected dementia (“trigger”) based on within-study assessments or clinical history. Dementia was adjudicated according to DSM-IV criteria. National Institute on Aging–Alzheimer’s Association criteria were used for AD and MCI subclassification.ResultsA total of 19,114 participants were followed over a median 4.7 years and 964 triggered further dementia assessments. There were 575 adjudicated dementia cases, and 41% were classified as clinically probable AD. There was no substantial difference in the risk of all dementia triggers (hazard ratio [HR], 1.03; 95% confidence interval [CI], 0.91–1.17), probable AD (HR, 0.96; 95% CI, 0.74–1.24), or MCI (HR, 1.12; 95% CI, 0.92–1.37) between aspirin and placebo. Cognitive change over time was similar in the aspirin and placebo groups.ConclusionsThere was no evidence that aspirin was effective in reducing risk of dementia, MCI, or cognitive decline. Follow-up of these outcomes after initial exposure is ongoing.Classification of evidenceThis study provides Class II evidence that for healthy older individuals, low-dose aspirin does not significantly reduce the incidence of dementia, probable AD, MCI, or cognitive decline.Clinicaltrials.gov identifierNCT01038583.

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