OBJECTIVES: Cardiovascular disease (CVD) is a common condition which accounted for over 17 million deaths globally in 2016. It is important to quantify the burden of CVD, particularly among at-risk groups, such as those with diabetes and/or suboptimal adherence. Furthermore, it is crucial to determine measures that may reduce the incidence of cardiovascular events, such as cardioprotective low-dose aspirin.

METHODS: A structured literature review was conducted across multiple databases. The search strategy included terms related to CVD, aspirin (restricted to the descriptor low-dose) and burden (clinical, economic and humanistic) of cardiovascular events. The search was limited from 2014–2019. Publications reporting on low-dose aspirin alongside diabetes or adherence were included.

RESULTS: In total 56 publications were included; 40 related to diabetes and 16 to adherence. Patients with diabetes are 2–3 times more likely to have CVD and subsequent CV events, contributing to the leading cause of mortality and 20–49% of total diabetes healthcare costs. Publications supported use of low-dose aspirin (75–162mg) in diabetes, reporting a significant reduction in serious vascular events (p<0.01), which led to cost-effectiveness in analyses from the US and China (ICER $8,801 and $2,244 per QALY, respectively). In patients with CVD, non-adherence (<80% compliance or not defined) to low-dose aspirin (75–160mg) increased the rate of cardiovascular events by 46%. Adherence to low-dose aspirin correlated with a three times lower risk of major adverse cardiac events and significantly lower adjusted mortality (p<0.05). Decreasing cardiovascular events with improved adherence could result in savings of $80 million and $32 million for primary and secondary prevention, respectively over 10 years.

CONCLUSIONS: Diabetes and non-adherence greatly increase the clinical and economic burden for cardiovascular events. Low-dose aspirin was shown to alleviate this burden and should be considered as an effective cost-saving option for populations at high-risk of CVD.