Acetylsalicylic acid in primary prevention of cardiovascular disease
Authors:
Roman Miklík 1,2,3; Otakar Jiravský 3
Authors‘ workplace:
Interní oddělení, Vojenská nemocnice Brno
1; Kardiologická klinika, Fakultní nemocnice a Lékařská fakulta Univerzity Karlovy v Plzni, Plzeň
2; Nemocnice Agel Třinec‑Podlesí, Třinec
3
Published in:
Vnitř Lék 2022; 68(4): 240-245
Category:
Review Articles
Overview
Acetylsalicylic acid is an effective and widely accepted essential drug in the secondary prevention of ischemic events. Its role in primary prevention has been studied for several decades and still remains controversial. Initial studies showed a reduction in both myocardial infarctions and ischemic strokes, without affecting overall or cardiovascular mortality, but the enrolled subjects were not treated with modern drugs and procedures in primary preventive care as they do today. Recently published studies have also not shown a mortality benefit, but in some sub-populations and groups of patients, the clinical benefit of aspirin continues to outweigh the risks associated with its long-term use. This review article will discuss the development of ASA in primary prevention, the results of the latest studies of the year 2018 and their meta-analyses, current indications for ASA treatment, as well as future perspectives.
Keywords:
Aspirin – primary prevention – clinical benefit – ischemic risk – risk of bleeding
Sources
1. Desborough MJR, Keeling DM. The aspirin story – from willow to wonder drug. Br J Haematol 2017;177(5):674-83.
2. Smith JB, Araki H, Lefer AM. Thromboxane A2, prostacyclin and aspirin: effects on vascular tone and platelet aggregation. Circulation 1980;62(6 Pt 2):V19-25.
3. Elwood PC, Cochrane AL, Burr ML et al. A Randomized Controlled Trial of Acetyl Salicyclic Acid in the Secondary Prevention of Mortality from Myocardial Infarction. Br Med J 1974;1(5905):436-40.
4. Bowman L, Mafham M, Wallendszus K et al. Effects of Aspirin for Primary Prevention in Persons with Diabetes Mellitus. N Engl J Med 2018;379(16):1529-39.
5. Gaziano JM, Brotons C, Coppolecchia R et al. Use of aspirin to reduce risk of initial vascular events in patients at moderate risk of cardiovascular disease (ARRIVE): a randomised, double‑blind, placebo‑ controlled trial. Lancet Lond Engl 2018;392(10152):1036–46.
6. McNeil JJ, Wolfe R, Woods RL et al. Effect of Aspirin on Cardiovascular Events and Bleeding in the Healthy Elderly. N Engl J Med 2018;379(16):1509-18.
7. Peto R, Gray R, Collins R et al. Randomised trial of prophylactic daily aspirin in British male doctors. Br Med J Clin Res Ed 1988;296(6618):313-6.
8. Steering Committee of the Physicians’ Health Study Research Group. Final report on the aspirin component of the ongoing Physicians’ Health Study. N Engl J Med 1989;321(3):129-35.
9. Roncaglioni MC. Low‑dose aspirin and vitamin E in people at cardiovascular risk: a randomised trial in general Practice. The Lancet 2001;357(9250):89-95.
10. Ridker PM, Cook NR, Lee I‑M et al. A Randomized Trial of Low‑Dose Aspirin in the Primary Prevention of Cardiovascular Disease in Women. N Engl J Med 2005;352(13):1293–304.
11. Graham I, Atar D, Borch‑Johnsen K et al. European guidelines on cardiovascular disease prevention in clinical practice: executive summary: Fourth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice. Eur Heart J 2007;28(19):2375-414.
12. Ikeda Y, Shimada K, Teramoto T, et al. Low‑Dose Aspirin for Primary Prevention of Cardiovascular Events in Japanese Patients 60 Years or Older With Atherosclerotic Risk Factors: A Randomized Clinical Trial. JAMA 2014;312(23):2510-20.
13. Piepoli MF, Hoes AW, Agewall S et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J 2016;37(29):2315-81.
14. Sarwar N, Gao P, Seshasai SRK et al. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta‑analysis of 102 prospective studies. Lancet Lond Engl 2010;375(9733):2215-22.
15. Rothwell PM, Wilson M, Elwin CE et al. Long‑term effect of aspirin on colorectal cancer incidence and mortality: 20-year follow‑up of five randomised trials. Lancet Lond Engl 2010;376(9754):1741-50.
16. Yazdanyar A, Newman AB. The burden of cardiovascular disease in the elderly: morbidity, mortality, and costs. Clin Geriatr Med 2009;25(4):563-77.
17. McNeil JJ, Woods RL, Nelson MR, et al. Effect of Aspirin on Disability‑free Survival in the Healthy Elderly. N Engl J Med 2018;379(16):1499-508.
18. Mahmoud AN, Gad MM, Elgendy AY et al. Efficacy and safety of aspirin for primary prevention of cardiovascular events: a meta‑analysis and trial sequential analysis of randomized controlled trials. Eur Heart J 2019;40(7):607-17.
19. Zheng SL, Roddick AJ. Association of Aspirin Use for Primary Prevention With Cardiovascular Events and Bleeding Events: A Systematic Review and Meta‑analysis. JAMA 2019;321(3):277-87.
20. Gelbenegger G, Postula M, Pecen L et al. Aspirin for primary prevention of cardiovascular disease: a meta‑analysis with a particular focus on subgroups. BMC Med 2019;17(1):198.
21. Arnett DK, Blumenthal RS, Albert MA et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/ American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2019;140(11):e596-646.
22. Visseren FLJ, Mach F, Smulders YM et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J 2021;42(34):3227-337.
23. Moayyedi P, Eikelboom JW, Bosch J, et al. Safety of Proton Pump Inhibitors Based on a Large, Multi‑Year, Randomized Trial of Patients Receiving Rivaroxaban or Aspirin. Gastroenterology 2019;157(3):682-691.
24. Bhatt DL, Grosser T, Dong J et al. Enteric Coating and Aspirin Nonresponsiveness in Patients With Type 2 Diabetes Mellitus. J Am Coll Cardiol 2017;69(6):603-12.
25. Cryer B, Bhatt DL, Lanza FL et al. Low‑dose aspirin‑induced ulceration is attenuated by aspirin‑phosphatidylcholine: a randomized clinical trial. Am J Gastroenterol 2011;106(2):272-7.
26. Ajufo E, Ayers CR, Vigen R et al. Value of Coronary Artery Calcium Scanning in Association With the Net Benefit of Aspirin in Primary Prevention of Atherosclerotic Cardiovascular Disease. JAMA Cardiol 2021;6(2):179-87.
27. Biondi‑Zoccai G, Wu Y, Serrano Jr. et al. Aspirin underuse, non‑ compliance or cessation: Definition, extent, impact and potential solutions in the primary and secondary prevention of cardiovascular disease. Int J Cardiol 2015;182:148-54.
Labels
Diabetology Endocrinology Internal medicineArticle was published in
Internal Medicine
2022 Issue 4
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