IDF2022-0582 Aspirin Use among Individuals with Diabetes in 48 Low-, Middle-, and High-income Countries

Background

In cardiovascular disease (CVD) secondary prevention, aspirin is recommended for most individuals. In the primary prevention of CVD, recent trials have called into question the role of aspirin among individuals with and without diabetes. Understanding population patterns of aspirin use can inform clinical and public health strategies to optimize its use.

Aim

To describe global patterns of aspirin use for the primary and secondary prevention of CVD in people with diabetes.

Method

We conducted a cross-sectional analysis of pooled, individual-participant data from 48 nationally representative health surveys conducted from 2013–2019 in low- (n = 6), lower-middle- (n = 21), upper-middle- (n = 15), and high-income (n = 6) countries. Our sample was non-pregnant individuals aged 40–69 years. Outcomes were the proportion of self-reported aspirin use among people with diabetes for primary prevention and secondary prevention of CVD. We estimated CVD risk among those using aspirin for primary prevention using the 2019 WHO risk prediction equations. Countries were weighted by adult population size.

Results

The pooled sample included 87,433 respondents, among whom 11,778 (15.9% [95% CI 15.0–16.8]) had diabetes. In the overall population with diabetes, aspirin use was 62.3% (54.3–69.7) among individuals with a history of CVD and 18.8% (16.2–21.7) among individuals without history of CVD. By income group, aspirin use among people with diabetes and a history of CVD was 42.2% (31.8–53.3) in low/lower-middle-income countries, 45.4% (33.7–57.6) in upper-middle-income countries, and 80.7% (69.4–88.5) in high-income countries. Among individuals with diabetes using aspirin for primary prevention, 32.5% (25.5–40.3) had CVD risk 10%, 52.7% (44.7–60.6) had CVD risk 10–20%, and 14.8% (11.3–19.2) had CVD risk >20%.

Conclusion

Aspirin was used by fewer than 50% of eligible people with diabetes for the secondary prevention of CVD in low- and middle-income countries, yet one-third of people with diabetes using aspirin for primary prevention are at low predicted CVD risk. There exists both an underuse and overuse of aspirin globally.