Aspirin in Primary Prevention: What Changed? A Critical Appraisal of Current Evidence

Dasa, Osama; Pepine, Carl J.; Pearson, Thomas A.

doi:10.1016/j.amjcard.2020.11.014

Cited by 12 publications

(10 citation statements)

References 66 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Its role in CRC specifically has been evaluated, where it was found to be effective in reducing the risk of CRC-related death in Randomized control trial (RCTs), thus suggesting that the antiplatelet action contributes to the prevention of both atherosclerosis and cancer [73,74]. As such, the decision to start a patient on aspirin would require assessment of each patient's risk-benefit profile [75]. The American College of Cardiology (ACC) recommends calculating 10-year CVD risk for patients aged 40-79 [66].…”

Section: Aspirinmentioning

confidence: 99%

Cancer and cardiovascular disease: can understanding the mechanisms of cardiovascular injury guide us to optimise care in cancer survivors?

Truong¹,

Scott²,

Pal³

et al. 2022

ecancer

View full text Add to dashboard Cite

Cancer and cardiovascular disease (CVD) are the leading causes of morbidity and mortality. Therefore, CVD deaths in cancer survivors remain a major challenge in improving cancer outcomes, especially in low and middle income countries (LMICs). Cancer and CVD share many common risk factors, both modifiable risk factors (obesity, diabetes and smoking) and non-modifiable factors such as inflammation. Additionally, some cancer therapies are associated with cardiac toxicity. These mechanisms drive increased CVD outcomes in cancer survivors, and understanding this relationship allows us to target therapies to combat such risks. Several commonly used pharmacotherapies for CVD demonstrate promise in cancer survivors for both primary and secondary prevention. Beta blockers and Angiotensin converting enzyme (ACE)-inhibitors have been shown in several studies to improve left ventricular ejection fraction (LVEF) in patients with already established LVEF decline following cancer therapy. Statin use during chemotherapy was associated with lower risk of heart failure and smaller declines in LVEF. Recent studies into the effects of anti-inflammatory medications on cardiovascular events in the noncancer population have demonstrated promising results and may prove to be an area of further investigation and possible benefit in the cancer population [Canakinumab Anti-Inflammatory Thrombosis Outcomes Study (CANTOS) and Colchicine Cardiovascu-lar Outcomes Trial (COLCOT)]. Additionally, several other medications including PCSK9 inhibitors, sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide 1 (GLP-1) agonists have been shown to modify inflammation, and therefore may provide cardiovascular benefits. While common pharmacotherapies used in CVD show promise in cancer survivors, their exact mechanisms remain poorly understood. Few studies evalu-ate their clinical effectiveness specifically in cancer survivors, as this patient population is excluded from most studies. Further investigation is warranted with more representation of cancer survivors before cost-effective recommendations are made. This is especially true in LMICs where resources are sparse for primary and secondary prevention in order to optimise care in this unique, high-risk population for CVD.

show abstract

Section: Aspirinmentioning

confidence: 99%

Cancer and cardiovascular disease: can understanding the mechanisms of cardiovascular injury guide us to optimise care in cancer survivors?

Truong¹,

Scott²,

Pal³

et al. 2022

ecancer

View full text Add to dashboard Cite

show abstract

“…Following the publication of three RCTs in 2018 the use of aspirin in primary prevention in cardiovascular disease is no longer routinely recommended and should only be considered, on a case-by-case basis, in those with a very high individual risk of cardiovascular events 13 .…”

Section: Antiplatelet Agentsmentioning

confidence: 99%

Endoscopy in patients on antiplatelet or anticoagulant therapy: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guideline update

et al. 2021

View full text Add to dashboard Cite

This is a collaboration between the British Society of Gastroenterology (BSG) and the European Society of Gastrointestinal Endoscopy (ESGE), and is a scheduled update of their 2016 guideline on endoscopy in patients on antiplatelet or anticoagulant therapy. The guideline development committee included representatives from the British Society of Haematology, the British Cardiovascular Intervention Society, and two patient representatives from the charities Anticoagulation UK and Thrombosis UK, as well as gastroenterologists. The process conformed to AGREE II principles, and the quality of evidence and strength of recommendations were derived using GRADE methodology. Prior to submission for publication, consultation was made with all member societies of ESGE, including BSG. Evidence-based revisions have been made to the risk categories for endoscopic procedures, and to the categories for risks of thrombosis. In particular a more detailed risk analysis for atrial fibrillation has been employed, and the recommendations for direct oral anticoagulants have been strengthened in light of trial data published since the previous version. A section has been added on the management of patients presenting with acute GI haemorrhage. Important patient considerations are highlighted. Recommendations are based on the risk balance between thrombosis and haemorrhage in given situations.

show abstract

“… 32 , 33 Consequently, the argument has been made that statin use in primary prevention has shown far greater consistent benefit, without the drawbacks of bleeding, and may offer a better “bang for your buck” compared with widespread aspirin use. 37 , 38 …”

Section: Primary Preventionmentioning

confidence: 99%

“…Whereas historical trials used “plain” aspirin, newer trials have started to include enteric-coated (EC) aspirin. 5 , 38 It is possible that EC aspirin may be less effective than regular aspirin, with suggestions of increased aspirin resistance in those receiving EC aspirin formulations and even reduced oral bioavailability at increased body weights. 38 All of these factors may be contributing to differences we are seeing in contemporary trial outcomes testing the efficacy of aspirin in primary prevention.…”

Section: Primary Preventionmentioning

confidence: 99%

Aspirin in the Modern Era of Cardiovascular Disease Prevention

Murphy

Curneen

McEvoy

2021

Methodist DeBakey Cardiovascular Journal

View full text Add to dashboard Cite

Aspirin’s antithrombotic effects have a long-established place in the prevention of cardiovascular disease (CVD), and its traditional use as a core therapy for secondary prevention of CVD is well recognized. However, with the advent of newer antiplatelet agents and an increasing understanding of aspirin’s bleeding risks, its role across the full spectrum of modern CVD prevention has become less certain. As a consequence, recent trials have begun investigating aspirin-free strategies in secondary prevention. For example, a contemporary metanalysis of trials that assessed P2Y 12 inhibitor monotherapy versus prolonged (≥ 12 months) dual antiplatelet therapy (which includes aspirin) after percutaneous coronary intervention reported a lower risk of major bleeding and no increase in stent thrombosis, all-cause mortality, myocardial infarction (MI), or stroke in the P2Y 12 monotherapy group. In contrast to secondary prevention, aspirin’s role in primary prevention has always been more controversial. While historical trials reported a reduction in MI and stroke, more contemporary trials have suggested diminishing benefit for aspirin in this setting, with no reduction in hard outcomes, and some primary prevention trials have even indicated a potential for harm. In this review, we discuss how changing population demographics, enhanced control of lipids and blood pressure, changes in the definition of outcomes like MI, evolution of aspirin formulations, and updated clinical practice guidelines have all impacted the use of aspirin for primary and secondary CVD prevention.

show abstract

Aspirin in Primary Prevention: What Changed? A Critical Appraisal of Current Evidence

Cited by 12 publications

References 66 publications

Cancer and cardiovascular disease: can understanding the mechanisms of cardiovascular injury guide us to optimise care in cancer survivors?

Cancer and cardiovascular disease: can understanding the mechanisms of cardiovascular injury guide us to optimise care in cancer survivors?

Endoscopy in patients on antiplatelet or anticoagulant therapy: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guideline update

Aspirin in the Modern Era of Cardiovascular Disease Prevention

Contact Info

Product

Resources

About