OBJECTIVES: Low-dose acetylsalicylic acid (ASA; 75-325 mg daily) is a mainstay of cardiovascular (CV) prevention. However, some patients taking low-dose ASA may experience upper gastrointestinal (GI) symptoms that are associated with poor adherence to and discontinuation of low-dose ASA. Established gastroprotective strategies, e.g. concomitant proton pump inhibitor (PPI) therapy, may ameliorate these symptoms and thus improve low-dose ASA adherence. METHODS: This subanalysis of a multinational, observational, non-interventional study (NCT00681759) conducted in the United States, Canada and France assessed PPI prescription rates (one-time retrospective survey) and daily PPI adherence rates (prospective 3-month eDiary phase) in adult patients with increased GI risk who had been prescribed low-dose ASA for management of CV risk. Here, increased GI risk was defined as a history of peptic ulcer and/or complications or additional antiplatelet use (clopidogrel, ticlopidine, dipyridamole). RESULTS: A total of 195 of the 1770 patients in the survey were identified as having increased GI risk (history of peptic ulcer and/or complications, n=109; concomitant antiplatelet therapy, n=74; both factors, n=12); 119 (61%) of whom were not prescribed a PPI. A total of 340 patients entered the eDiary phase, of whom 110 were prescribed a PPI before the first diary day; of these, 79 patients were prescribed a daily PPI for the 3-months. Among these patients, fewer than half (n=37) took >75% of prescribed daily PPIs. Almost one-third (n=25) did not take their prescribed daily PPI at all during the 3-month phase. CONCLUSIONS: PPI prescription and adherence rates are low among patients with increased GI risk receiving low-dose ASA for CV risk management. Strategies that deliver gastroprotection with improved adherence rates during low-dose ASA therapy in patients with increased GI risk may be warranted.