Esomeprazole and aspirin fixed combination for the prevention of cardiovascular events

Abstract

Low dose aspirin therapy plays a fundamental role in both the primary and secondary prevention of cardiovascular events. Although the evidence using low dose aspirin for secondary prevention is well-established, the decision to use aspirin for primary prevention is based on an evaluation of the patient’s risk of cardiovascular events compared to their risk of adverse events, such as bleeding. In addition to the risk of bleeding associated with long term aspirin administration, upper gastrointestinal side effects, such as dyspepsia often lead to discontinuation of therapy, which places patients at an increased risk for cardiovascular events. One option to mitigate adverse events and increase adherence is the addition of esomeprazole to the medication regimen. This review article provides an evaluation of the literature on the concomitant use of aspirin and esomeprazole available through February 2013. The efficacy, safety, tolerability, cost effectiveness, and patient quality of life of this regimen is discussed. A summary of the pharmacokinetic and pharmacodynamic interactions between aspirin and esomeprazole, as well as other commonly used cardiovascular medications are also reviewed. The addition of esomeprazole to low dose aspirin therapy in patients at high risk of developing gastric ulcers for the prevention of cardiovascular disease, significantly reduced their risk of ulcer development. Pharmacokinetic and pharmacodynamic studies suggested that esomeprazole did not affect the pharmacokinetic parameters or the antiplatelet effects of aspirin. Therefore, for those patients who are at a high risk of developing a gastrointestinal ulcer, the benefit of adding esomeprazole likely outweighs the risks of longer term proton pump inhibitor use, and the combination can be recommended. Administering the two agents separately may also be more economical. On the other hand, for those patients at lower risk of developing a gastrointestinal ulcer, both the additional risk and cost make the inclusion of a proton pump inhibitor unwarranted.

Pharmacological activation of FOXO3 suppresses triple-negative breast cancer in vitro and in vivo

“…In addition, based on the known activities of existing drugs, the mechanisms of new actions of these drugs tend to be more predictable and successful than those made of entirely unknown compounds. For examples, while aspirin has been previously used as an analgesic to relieve pain, it has been recently shown to exert anti-platelet activity and is rapidly being repurposed for preventing cardiovascular diseases [42]. Before thalidomide was found to cause birth defects, it was used to treat morning sickness in pregnant women.…”

Anti-atherosclerotic effects of perilla oil in rabbits fed a high-cholesterol diet

“…To date, statins and anti-coagulants have been used to improve hyperlipidemia and blood flow, and thereby to prevent atherosclerosis and cardiovascular diseases [ 42 43 44 ]. In fact, it is well known that platelet activation and aggregation is an initial feature of thrombus formation on the injured arterial endothelium undergoing atherosclerosis [ 45 ].…”

PA32540 for the secondary prevention of cardiovascular disease in patients at risk for aspirin-associated gastric ulcers

“…A significant proportion of patients, however, continue to experience gastrointestinal bleeding while using EC-ASA [15] . Proton pump inhibitor (PPIs), on the other hand, have shown greater promise than EC-ASA in minimizing gastrointestinal side effects in several randomized trials [16] . Continuous PPI use has been associated with a lower risk of gastrointestinal ulcers or bleeding compared with intermittent or no PPI use [17] .…”