Protective Effects of Aspirin against Acute Myocardial Infarction and Death in Men with Unstable Angina

Abstract

We conducted a multicenter, double-blind, placebo-controlled randomized trial of aspirin treatment (324 mg in buffered solution daily) for 12 weeks in 1266 men with unstable angina (625 taking aspirin and 641 placebo). The principal end points were death and acute myocardial infarction diagnosed by the presence of creatine kinase MB or pathologic Q-wave changes on electrocardiograms. The incidence of death or acute myocardial infarction was 51 per cent lower in the aspirin group than in the placebo group: 31 patients (5.0 per cent) as compared with 65 (10.1 per cent); P = 0.0005. Nonfatal acute myocardial infarction was 51 per cent lower in the aspirin group: 21 patients (3.4 per cent) as compared with 44 (6.9 per cent); P = 0.005. The reduction in mortality in the aspirin group was also 51 per cent--10 patients (1.6 per cent) as compared with 21 (3.3 per cent)--although it was not statistically significant; P = 0.054. There was no difference in gastrointestinal symptoms or evidence of blood loss between the treatment and control groups. Our data show that aspirin has a protective effect against acute myocardial infarction in men with unstable angina, and they suggest a similar effect on mortality.

C‐reactive protein as a marker for active coronary artery disease in patients with chest pain in the emergency room

“…31 Activated vascular wall cells, such as smooth muscle cells, endothelial cells, macrophages, and T lymphocytes, may play a central role because they produce interleukins, growth factors, procoagulant activity, and adhesion molecules that alter the vascular reactivity and thrombogenicity. 32,33 Ridker et al 34 have demonstrated that in apparently healthy men, high baseline plasma CRP level predicts the risk of future myocardial infarction, and that the use of aspirin, a well known anti-inflammatory drug, was associated with significant reduction in the risk of acute myocardial infarction.…”

Clinical evidence of dose-dependent interaction between aspirin and angiotensin-converting enzyme inhibitors

“…The widespread use of aspirin probably contributes significantly to reduction of cardiovascular morbidity and mortality among high risk hypertensive patients with concomitant cardiovascular problems 35 and therefore there is a great potential for combined treatment with aspirin and ACE-I. Evidences emerging from randomised trials in patients with ischaemic heart disease show that aspirin in low, 36 intermediate 37 and high doses 38 bears a very similar extent of favourable effects on survival. Particularly, after myocardial infarction in the absence of heart failure, the overall benefits of both ACE-I and aspirin are well established and, although the benefit from the combination may be reduced, the combination will still be better than either used alone.…”

Secondary prevention of heart disease amongst patients with lipid abnormalities: practice and trends in the United States

“…The six cornerstones in the comprehensive medical management of established CAD include antithrombotic therapy, in particular aspirin [15,16,[19][20][21][22][23], antihypertensive therapy, diet, exercise [24][25][26], smoking cessation and treatment of lipid abnormalities [1,2]. The detailed discussion of each of these approaches is beyond the scope of this report.…”