Use and Misuse of Aspirin in Primary Cardiovascular Prevention

Abstract

The use of low-dose aspirin in primary prevention of cardiovascular (CV) events in healthy or apparently healthy people is a widely debated topic. Many arguments indicate that “primary prevention” is only a conventional definition and that the transition from primary to secondary prevention represents a continuum of increasing levels of CV risk. Although there are no direct proofs of a different efficacy of aspirin at different CV risk levels, in low-risk populations aspirin will appear to be less efficient. In fact, the lower number of events occurring in patients at low risk yields lower absolute numbers of events prevented. As many as 6 meta-analyses of trials of primary CV prevention with aspirin versus placebo, performed between 2009 and 2016, confirmed the above concepts and showed a concordant, significant reduction in nonfatal myocardial infarction, with no significant effects on stroke, as well as on CV and all-cause mortality. The recent demonstration of a moderate protective effect of aspirin on cancer (especially colorectal) confers, however, additional value to the use of aspirin, although unusually long durations of treatment and optimal daily compliance seem to be necessary. Because aspirin increases the bleeding risk, the evaluation of its net clinical benefit is an important point of debate. Thus, it is justified to search for a cutoff level of global CV risk above which the net clinical benefit of aspirin becomes evident. Such a threshold value has been calculated considering the data of 9 primary prevention trials, by the Thrombosis Group of the European Society of Cardiology, and has been indicated as a risk value of 2 or more major CV events per 100 persons per year. Also, in the recent 2016 US Guidelines, the main criterion adopted for the indication of aspirin is the level of global CV risk (suggested cutoff is 1 or more major CV events per 100 persons per year). Beyond the different values selected, it is seems very important to introduce to clinical practice and future trials a new criterion based on the level of global CV risk.

Frequency of Aspirin Misuse among Hypertensive Patients in Babylon Province

“…The effect of aspirin on control of BP is still a matter of debate (10) . Regarding the use of aspirin in healthy or apparently healthy people as primary prevention , there are no direct proofs of its efficacy, but in low-risk populations it may be of no benefit or may be risky (7) . In 2016, the (USPSTF) recommendations about aspirin use in primary CVD prevention in has been updated .…”

“…The main outcomes to be measured are MI, stroke, and death from CVD. In addition to other outcomes including hospital admission , intervention of coronary disease, incident angina, all-cause mortality are sometimes added as ancillary end points these are applied to apparently healthy persons (7) .…”

Spurious Hyperchloremia in the Presence of Elevated Plasma Salicylate: A Cohort Study

“…Table 1 summarizes the clinical effects of salicylate based on blood levels. In recent decades, clinical indications for aspirin use have surpassed the traditional analgesic and antipyretic effects; it is increasingly used as an antiplatelet and even antineoplastic agent [3-5]. With the marked increase in aspirin use there has been a concomitant rise in the incidence of ­salicylate toxicity.…”