Aspirin For Primary Prevention Research Articles

Aspirin for Primary Prevention of Cardiovascular Disease: What We Now Know

Cardiovascular disease (CVD), including coronary artery disease and stroke, is the leading cause of death worldwide. Advances in primary and secondary prevention of CVD have improved patient prognoses and outcomes, however, it is imperative that the clinician and patient engage in early risk factor screening and preventive management of modifiable risk factors for CVD. In addition to blood lipid and blood pressure lowering medications, aspirin has been a long-standing therapy targeted to the prevention of CVD based on its antiplatelet and anti-inflammatory activity. However, recent articles and reports on updates to clinical guidelines for the primary prevention of CVD have resulted in confusion about aspirin recommendations. This review aims to assess the latest guidance on aspirin in CVD prevention and how to identify appropriately at-risk patients who may benefit from low-dose aspirin therapy as part of their CVD preventive healthcare choices. Additionally, this review will provide practical application guidance about clinician-patient conversations to clearly explain the benefits and risks of aspirin use and ensure a patient-centric decision to initiate aspirin therapy.

Low-dose aspirin for prevention of cardiovascular mortality in patients with type 2 diabetes and chronic kidney disease: A real-world nationwide cohort study.

Cardiovascular mortality risk is elevated among patients with diabetes and concurrent chronic kidney disease. However, controversy surrounds the use of aspirin for primary prevention within this population. This study aims to assess the effectiveness and safety of low-dose aspirin for primary prevention in patients with diabetes and pre-end-stage renal disease. This was a retrospective population-based cohort study using the National Health Insurance Research Database in Taiwan. The study included adults with type 2 diabetes who were enrolled in the pre-end-stage renal disease pay-for-performance program and had no atherosclerotic cardiovascular disease. We used propensity score analysis to control baseline characteristics between the two groups. Clinical outcomes including cardiovascular mortality, all-cause mortality, major bleeding, and renal disease progression were compared between patients who first received aspirin and those who did not. Between January 2012 and December 2015, a total of 2,155 low-dose aspirin users and 6,737 nonaspirin users were identified. Following propensity score adjustment, aspirin use exhibited a comparable risk of cardiovascular death compared with nonaspirin users (adjusted hazard ratio [aHR] 1.12; 95% confidence interval [CI] 0.65-1.95; P = 0.681). The risk of all-cause mortality was similar between the two groups (aHR 1.07; 95% CI 0.92-1.24; P = 0.385). Similar risks were observed in terms of major bleeding and renal disease progression. In patients with diabetes and pre-end-stage renal disease who lacked atherosclerotic cardiovascular disease, low-dose aspirin did not demonstrate a reduction in mortality. These findings do not support the use of aspirin for primary prevention in this high-risk population.

Updated Lipoprotein(a) Genomic Risk Score and Aspirin for Primary Prevention of Cardiovascular Events

Updated Lipoprotein(a) Genomic Risk Score and Aspirin for Primary Prevention of Cardiovascular Events

Outcomes of diabetic patients with acute coronary syndromes treated with aspirin in primary prevention

Abstract Introduction The use of aspirin in primary prevention (PP) remains a matter of international debate. In type 2 diabetes mellitus (DM2) patients with high/very high cardiovascular (CV) risk, low dose aspirin may be considered for PP (class IIb, evidence level A) in european guidelines in the absence of hemorrhagic contraindication. Objectives Our aim was to analyze in-hospital and one year follow-up (FU) outcomes of acute coronary syndrome (ACS) DM2 patients without previous atherosclerotic CV disease (ASCVD) treated with vs without aspirin in primary prevention. Methods A retrospective analysis was carried out of DM2 patients without established ASCVD admitted with ACS included in the Portuguese Registry of ACS between 2010-2021. Patients were divided in two groups regarding the use of aspirin in primary prevention (with-AG and without-NAG). Composite primary outcome (re-infarction, heart failure, shock, death – in-hospital) and secondary outcomes (one-year all-cause mortality and mortality/rehospitalization) were compared in both groups. Independent predictors of primary outcome were assessed by multivariate logistic regression. Survival analysis and cox regression were used to compare and identify predictors of secondary outcomes. P value < 0.05 indicates statistical significance. Results A total of 4517 patients were analyzed, mean age 68±12 years, 64.8% male. AG showed higher rates of hypertension (89.9%, p<0.001), dyslipidemia (74.1%, p<0.001), history of heart failure (9.2%, p<0.001), valvular disease (3.9%, p=0.002) and chronic renal disease (12.3%, p<0.001). STEMI presentation was more frequent in NAG (48%, p<0.001). Multivessel disease (mainly three vessels disease) was more frequent in AG (32.7%, p<0.001), but anterior descendent (AD) as culprit artery was more common in NAG (40.3%, p=0.013). Both groups had no difference in major hemorrhage occurrence. Primary outcome was more frequent in AG (18.6%, p=0.034). One-year all-cause mortality and mortality/rehospitalization were higher in AG (9.90%, p=0.004 and 32.9%, p=0.017, survival analysis). Independent predictors of primary outcome were aspirin in primary prevention (OR 1.38, p=0.026), age (OR 1.59, p<0.001), valvular disease (OR 4.46, p<0.001), STEMI at presentation (OR 2.20, p<0.001), LVEF <40% (OR 4.40, p<0.001) and Killip-Kimball class > I (OR 12.9, p<0.001). Aspirin in primary prevention (HR 1.84, p=0.004), chronic lung disease (HR 5.68, p<0.001), and Killip-Kimball class > I (HR 3.27, p<0.001) were predictors of one-year all-cause mortality. Conclusion DM2 patients with ACS treated with aspirin in primary prevention had worst in-hospital and one-year FU outcomes. Although with higher rates of three vessels disease, PP with aspirin showed less AD disease and STEMI presentation, with similar major clinical hemorrhage.

Aspirin overuse in primary prevention: nationwide temporal trends in low-dose aspirin therapy for primary prevention of cardiovascular disease in adults with and without diabetes

Abstract Background Aspirin therapy for primary prevention of cardiovascular disease (CVD) is controversial. European Society of Cardiology guideline recommendations have changed in the last decades, and aspirin is currently not recommended in individuals with low/moderate cardiovascular (CV) risk but may be considered in high-risk individuals with diabetes. Purpose We report temporal trends in primary prevention aspirin prescription among individuals with and without diabetes and describe characteristics of incident aspirin users. Methods Using Danish nationwide registries, we identified incident and prevalent aspirin users in a population ≥40 years without CVD, eligible for primary preventive aspirin therapy from 2000 through 2020. Temporal trends in aspirin use with and without diabetes were assessed, as were CV risk factors among incident users. Individuals in Denmark are primarily seen by general practitioners who have a gate-keeper function for secondary hospital-based care. Results A total of 522,680 individuals started aspirin therapy during the study period. The number of incident users peaked in 2002 (39,803 individuals, 1.78% of the eligible population) and was lowest in 2019 (11,898 individuals, 0.49%), with similar trends for subjects with and without diabetes (Figure 1). A large proportion of incident users had no CV risk factors (diabetes, hypertension, hypercholesterolemia, or chronic obstructive pulmonary disease [a proxy for smoking]); however, this proportion decreased from 53.9% in 2000 to 30.9% in 2020 (Figure 2). The number of prevalent aspirin users peaked at 7.7% in 2008 and was 3.3% in 2020. For subjects with diabetes, the peak was observed in 2009 at 38.5% and decreased to 17.1% in 2020. Conclusion Prescription of aspirin for primary prevention of CVD has decreased over the last two decades in individuals both with and without diabetes. However, aspirin appears to be inappropriately prescribed in many primary prevention adults as a large proportion of incident users had no CV risk factors. Efforts to inform appropriate prescription of aspirin are needed, e.g., by improved guidance for general practitioners.Figure 1Figure 2

Abstract 18737: Coronary Artery Calcium for Allocation of Aspirin in Light of the 2022 USPSTF Guideline Recommendations: Results From the Multi-Ethnic Study of Atherosclerosis (MESA)

Introduction: The 2022 USPSTF guidelines issued a grade C recommendation for aspirin in patients aged 40-59 and recommended against its use in patients ≥ 60 years. We sought to assess if coronary artery calcium (CAC) would allow for personalized allocation of aspirin. Methods: Using MESA, aspirin naïve participants without high-risk bleeding features were identified. Participants were grouped by age into <60, ≥ 60 and stratified by CAC and ASCVD risk. The number needed to treat (NNT 5 ) and number needed to harm (NNH 5 ) was assessed by applying a 11% relative risk reduction in CVD and a 44% relative risk increase in major bleeding (2022 USPSTF meta-analysis) to the observed CVD and bleeding events from MESA Results: Of 6,814 participants, 4,506 met inclusion criteria. 2,235 were <60 years and 2,268 were ≥ 60 years. Figure-1 displays the interplay between baseline estimated ASCVD risk and CAC burden. In participants <60 years of age, both CAC and ASCVD risk >10% identified subgroups in whom the NNT was lower than the NNH: CAC 1-99 (NNT 5 -313, NNH 5 -517); CAC ≥100 (NNT 5 -152, NNH 5 -367); ASCVD risk >10% (NNT 5 -155, NNH 5 -554) Fig-1. In those ≥ 60 years CAC ≥100 identified subgroups with a lower NNT 5 -128 than NNH 5 -168, while ASCVD risk stratification did not. 6% of adults <60 years with <10% ASCVD risk and 30.3% of adults ≥ 60 years who had CAC ≥100, and who demonstrated benefit from the use of Aspirin, would not qualify for the use of aspirin using only ASCVD risk as per the 2022 USPSTF guideline recommendations. Conclusions: CAC identifies subgroups of patients <60 as well as those ≥ 60 years who would derive a net benefit from aspirin in primary prevention. A significant proportion of patients will be missed if only ASCVD risk scores are used for allocation of aspirin. CAC should be used to risk stratify individuals to personalize the allocation of aspirin

Abstract 15993: The Association of Aspirin With and Without Statin on Cardiovascular Outcomes in Primary Prevention Patients With Diabetes Mellitus

Background: The role of aspirin in primary prevention of ASCVD amongst high-risk individuals with diabetes mellitus remains unclear. We investigated aspirin use with and without statin and its association with future ASCVD events in a cohort of real-world primary prevention patients with diabetes mellitus. Methods: Primary prevention patients with diabetes were stratified based on HbA1c levels (6.5-7%, 7-9%, >9%) and 10-year ASCVD risk (High-risk [≥20%]). Aspirin use was defined as no use, seldom used (<30% of the time), sometimes used (≥30% - < 70% of the time), and often used (≥70% of the time). Cox regression assessed HRs of myocardial infarction (MI), stroke, and mortality with aspirin use. Results: Of 79, 597 patients with diabetes, 44.6% were classified as high-risk. These patients showed highest utilization of aspirin (45.7%) and statin (44.9%). Compared to high-risk patients with diabetes and an HbA1c of >9% on both a statin and an aspirin, those on statin alone had higher risk of MI [HR MI 1.74 (1.44-2.212), p <0.001], ischemic stroke [HR STROKE 2.52 (1.92-3.29), p <0.001], and mortality [HR 1.67 (1.27-2.19), p <0.001] (Table). Aspirin use alone was associated with higher risk of MI [HR 3.11 (2.42-4.00), p <0.001], ischemic stroke [HR 3.12 (2.08-4.67), p <0.001], and mortality [HR 3.77 (2.71-5.23), p < 0.0004] in the high-risk population with HbA1c >9% (Table). At all A1c levels, patients on no statin or aspirin were at significantly higher risk for MI, stroke, and mortality (Table). In high-risk patients with an HbA1c >9%, ASA use ≥ 70% resulted in significantly lower risk of MI [HR 0.58 (0.49-0.69), p<0.001)], ischemic stroke [HR 0.36 (0.28-0.46), p<0.001] and mortality [HR 0.52 (0.42-0.66), p<0.001]. Conclusion: Low dose aspirin may play a role in prevention of ASCVD events in high-risk patients with diabetes. Future studies can clarify the risk-benefit ratio of using aspirin with statin in patients with poor glycemic control for primary prevention of ASCVD events.

Abstract 15944: Aspirin Use for Primary Prevention in High-Risk Patients: Insights From a Large Healthcare Network

Background: Recently, the value of routine use of aspirin in primary prevention for atherosclerotic cardiovascular disease (ASCVD) has come into question. We investigated patients with a high 10-year ASCVD risk profile to evaluate the magnitude of protection afforded by aspirin with and without statin in prevention of ASCVD events. Methods: Primary prevention patients were stratified based on 10-year ASCVD risk (High [20%]). Aspirin use was categorized over the 6-year follow-up period as “None”, “seldom” (<30% of follow up time), “sometimes” (>30 to =<70%), and often used (≥70% of the time). Cox regression models were used to assess HRs of MI, ischemic stroke and mortality with aspirin or statin use alone compared to a combination of aspirin and statin. Results: 69,955 patients qualified as “high” 10-year ASCVD risk. In fully adjusted models, aspirin use ≥ 30% was associated with significantly lower risk of MI [HR ASA use ≥ 70% 0.76 (0.72-0.80), p <0.001], ischemic stroke [HR ASA use ≥ 70% 0.83 (0.77-0.90), p <0.007], and mortality [HR ASA use ≥ 70% 0.78 (0.74-0.82), p <0.001] in high-risk patients compared to no aspirin use ( Table ). Compared to patients on both a statin and aspirin, patients on statin alone had increased risk of MI [HR 1.30 (1.06-1.60), p = 0.013]. Patients on aspirin alone had increased risk of MI [HR 1.74 (1.34-2.26), p <0.001] and mortality [HR 1.70 (1.27-2.28), p < 0.0004] versus those on aspirin and statin. Patients not on any aspirin or statin were at significantly increased risk for MI [HR 2.28 (2.08-2.49), p<0.001], ischemic stroke [HR 1.77 (1.56-2.00), p<0.001), and mortality [HR 2.16 (1.60-2.90), p<0.001] compared to those taking both aspirin and statin. Conclusions: Low dose aspirin may still have a role in primary prevention of ASCVD events amongst high-risk patients when added to statin therapy. Risk-benefit profile of each high-risk primary prevention patient should be assessed for initiating or discontinuing low dose aspirin therapy

Identifying and reducing inappropriate aspirin use in primary care

ObjectiveRecent studies have called into question the safety of aspirin use for the primary prevention of atherosclerotic cardiovascular disease, particularly in older adults. Therefore, the objectives of this study were...

Specialty preference for cardiovascular prevention practice in the Southeast US and role of a preventive cardiologist.

Cardiovascular disease (CVD) prevention is practiced concurrently by providers from several specialties. Our goal was to understand providers' preference of specialties in CVD prevention practice and the role of preventive cardiologists. Between 11 October 2021 and 1 March 2022, we surveyed providers from internal medicine, family medicine, endocrinology, and cardiology specialties to examine their preference of specialties in managing various domains of CVD prevention. We examined categorical variables using Chi square test and continuous variables using t or analysis of variance test. Of 956 invitees, 263 from 21 health systems and 9 states responded. Majority of respondents were women (54.5%), practicing physicians (72.5%), specializing in cardiology (43.6%), and working at academic centers (51.3%). Respondents favored all specialties to prescribe statins (43.2%), ezetimibe (37.8%), sodium-glucose cotransporter-2 (SGLT2) inhibitors (30.5%), and aspirin in primary prevention (36.3%). Only 7.9% and 9.5% selected cardiologists and preventive cardiologists, respectively, to prescribe SGLT2 inhibitors. Most preferred specialists (i.e. cardiology and endocrinology) to manage advanced lipid disorders, refractory hypertension, and premature coronary heart disease. The most common conditions selected for preventive cardiologists to manage were genetic lipid disorders (17%), cardiovascular risk assessment (15%), dyslipidemia (13%), and refractory/resistant hypertension (12%). For CVD prevention practice, providers favored all specialties to manage common conditions, specialists to manage complex conditions, and preventive cardiologists to manage advanced lipid disorders. Cardiologists were least preferred to prescribe SGLT2 inhibitor. Future research should explore reasons for selected CVD prevention practice preferences to optimize care coordination and for effective use of limited expertise.

Association of low-dose aspirin use for primary prevention with self-reported kidney stones prevalence: a cross-sectional study.

To investigate the association between low-dose aspirin use for primary prevention and self-reported kidney stones prevalence in the 40-79years old population. We conducted a cross-sectional study based on the United States population data from the National Health and Nutrition Examination Survey 2011-2018. Baseline demographical and clinical data were collected. The univariate and multivariate regression was performed to identify confounding factors and assess the relationship between aspirin use for primary prevention and the prevalence of self-reported kidney stones. A propensity-score matching was used to identify patients with similar baseline characteristics to adjust for the bias caused by confounding factors. A total of 10,256 low-dose aspirin-use participants were included in this study. 10.4% of participants reported a history of kidney stones, and 18.5% reported a continuous use of low-dose prophylactic aspirin. Multivariate logistic regression analysis showed that low-dose preventive aspirin use had significantly increased the odds of self-reported kidney stones (OR = 1.245; 95% CI: 1.063-1.459; p = 0.007). In subgroup analysis, this finding was primarily limited to males (OR = 1.311), non-hypertensive participants (OR = 1.443), diabetic participants (OR = 1.380), and older (60 ≤ Age < 80) (OR = 1.349). The propensity-score matched analyses supported this result after adjusting for the bias caused by potential confounders (OR = 1.216; 95% CI: 1.011-1.462; p = 0.038). In this study, there exists a significant relationship between low-dose aspirin for primary prevention and self-reported kidney stones, primarily among males, no hypertensive participants, diabetics, or older adults. Further studies are needed to elucidate the mechanisms underlying these findings in the future.

Low-Dose Aspirin for Primary Prevention of Cardiovascular Events Comparing East Asians With Westerners: A Meta-Analysis

BackgroundEast Asians have shown different risk profiles for both thrombophilia and bleeding than Western counterparts. ObjectivesThe authors sought to evaluate the effect of low-dose aspirin for primary prevention between these populations. MethodsWe searched randomized clinical trials (RCTs) for intervention with low-dose aspirin (≤100 mg once daily) in participants without symptomatic cardiovascular disease until December 31, 2021. The number of events between the arms was extracted for analysis. Pooled risk ratios (RRs) and risk differences (RDs) were analyzed in each population. Outcomes included a major adverse cardiovascular event (MACE), cardiovascular death, myocardial infarction, stroke, and major bleeding (intracranial hemorrhage and major gastrointestinal bleeding). ResultsTwo RCTs included 17,003 East Asians, and 9 RCTs had 117,467 Western participants. Aspirin treatment showed a similar effect in reducing the MACE rate (RR of East Asians: 0.87; 95% CI: 0.71-1.05; RR of Westerners: 0.90; 95% CI: 0.85-0.95) (Pinteraction = 0.721). In contrast, the risk of major bleeding during aspirin vs control was greater in the East Asian population (RR: 2.48; 95% CI: 1.86-3.30) compared with the Western population (RR: 1.45; 95% CI: 1.26-1.66) (Pinteraction = 0.001), which was driven by more frequent gastrointestinal bleeding (RR of East Asians: 3.29; 95% CI: 2.26-4.80 vs RR of Westerners: 1.56; 95% CI: 1.29-1.88) (Pinteraction < 0.001). The net RDs (RD of MACE plus RD of major bleeding) were 8.04 and 0.72 per 1,000 persons in East Asian and Western participants, indicating 124 and 1,389 of the net number needed to harm, respectively. ConclusionsLow-dose aspirin for primary prevention in East Asians must be cautiously prescribed because of the increased risk of major bleeding relative to Western counterparts.

Aspirin for primary prevention in patients with high cardiovascular risk: insights from CORE-Thailand registry

Aspirin may be considered for primary prevention in non-elderly patients with high cardiovascular risk. However, contemporary management aimed at aggressive cardiovascular risk factor control may alter benefit-risk ratio of aspirin. Therefore, we aimed to examine the effect of aspirin for primary prevention on the long-term MACEs in a large cohort registry. Cohort Of patients with high Risk for cardiovascular Events (CORE-Thailand) registry is a prospective, multicenter, observational, longitudinal study of Thai patients with high atherosclerotic risk. Patients with established atherosclerotic cardiovascular diseases were excluded. Among 4259 patients with multiple cardiovascular risk factors, 1945 (45.7%) patients used aspirin. After propensity score matching, there were 3228 patients remained in post-matching analysis. During the median follow-up period of 58.2 months, we demonstrated that aspirin use increased risk of long-term MACEs in pre-matching cohort (unadjusted HR 1.76, 95% CI 1.43–2.17, P < 0.001) and post-matching cohort (HR 1.66 (1.31–2.10), P < 0.001). In addition, patients taking aspirin had a higher risk of bleeding than non-aspirin users in pre-matching cohort (unadjusted HR 2.28, 95% CI 1.09–4.75, P = 0.028). We demonstrated that aspirin was associated with increased risk of long-term MACEs in patients with multiple cardiovascular risk factors. Due to the non-randomized design, our results should be interpreted with caution.

Clinicians' self-reported efficacy in cardiovascular prevention practice in the southeastern United States

Aim: We assessed self-reported efficacy in cardiovascular prevention practice among internal medicine, family medicine, endocrinology and cardiology clinicians. Patients &amp; methods: We emailed a 21-item questionnaire to 956 physicians, nurse practitioners, physician assistants and pharmacists. Results: 264 clinicians responded (median age: 39 years, 55% women, 47.9% specialists). Most expressed high self-efficacy in lifestyle counselling, prescribing statins, metformin, and aspirin in primary prevention, but low self-efficacy in managing specialized conditions like elevated lipoprotein(a). Compared with specialists, PCPs expressed lower self-efficacy in managing advanced lipid disorders and higher self-efficacy in prescribing sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists. Conclusion: Self-efficacy in cardiovascular prevention varied across specialties. Future research should explore relevant provider, clinic and system level factors to optimize cardiovascular prevention.

Accuracy of Electronic Health Record–Documented Aspirin for Primary Prevention in Adult Outpatients

This quality improvement study examines the accuracy of electronic health record (EHR) documentation of aspirin use for primary prevention of atherosclerotic cardiovascular disease in adult outpatients.

Aspirin deprescribing in patients on oral anticoagulation for atrial fibrillation or venous thromboembolism: A national survey of clinician practices

AbstractIntroductionConcomitant use of oral anticoagulation (OAC) and aspirin increases bleeding risk without decreasing thromboembolic events compared with OAC monotherapy. Weak guideline recommendations and limited data exist for deprescribing aspirin for primary prevention or stable coronary artery disease in patients already on OAC for atrial fibrillation (AF) or venous thromboembolism (VTE).ObjectivesThe objective of this study was to identify aspirin deprescribing practices among clinicians for patients on OAC for AF or VTE and concomitant aspirin for non‐compelling reasons.MethodsA cross‐sectional, national survey was electronically distributed to pharmacists and non‐pharmacists (physicians, nurse practitioners, physician assistants). Co‐primary end points were composite aspirin discontinuation rates in patients on OAC for AF or VTE in primary prevention and stable coronary artery disease (CAD) cases. Key secondary end points were clinician comfort level with deprescribing aspirin and availability of institutional protocols.ResultsThree hundred four responses were included: 212 (69.7%) pharmacists and 92 (30.3%) non‐pharmacists. Mean age of respondents was 35.4 years, and 37.4% male. In the primary prevention cases, pharmacists were more likely to discontinue aspirin than non‐pharmacists (76.7% vs. 54.6%, p &lt; 0.001). In the stable CAD cases, composite rates of aspirin discontinuation by pharmacists and non‐pharmacists were similar (41.7% vs. 40.1%, p = 0.140). More pharmacists than non‐pharmacists stated that their aspirin deprescribing decisions were independent of the type of OAC that was used (60.4% vs. 35.9%, p &lt; 0.001). Pharmacists were more likely to discontinue aspirin after discussing with patients compared with non‐pharmacists (62.7% vs. 47.8%, p = 0.017). 27.3% of clinicians reported having a protocol to deprescribe aspirin at their institution/clinic.ConclusionThere are variations in aspirin deprescribing practices among clinicians in patients on OAC for AF or VTE and without compelling indications for aspirin. Further studies and stronger recommendations are warranted to guide clinicians regarding optimal antithrombotic therapy in these scenarios. Lack of institutional protocols for aspirin deprescribing creates opportunities for future quality improvement initiatives.

Clinical characteristics and treatment patterns of pregnant women with hypertension in primary care in the Federal Capital Territory of Nigeria: cross-sectional results from the hypertension treatment in Nigeria Program

BackgroundHypertensive disorders of pregnancy, including hypertension, are a leading cause of maternal mortality in Nigeria. However, there is a paucity of data on pregnant women with hypertension who receive care in primary health care facilities. This study presents the results from a cross-sectional analysis of pregnant women enrolled in the Hypertension Treatment in Nigeria Program which is aimed at integrating and strengthening hypertension care in primary health care centres.MethodsA descriptive analysis of the baseline results from the Hypertension Treatment in Nigeria Program was performed. Baseline blood pressures, treatment and control rates of pregnant women were analysed and compared to other adult women of reproductive age. A complete case analysis was performed, and a two-sided p value < 0.05 was considered statistically significant.ResultsBetween January 2020 to October 2022, 5972 women of reproductive age were enrolled in the 60 primary healthcare centres participating in the Hypertension Treatment in Nigeria Program and 112 (2%) were pregnant. Overall mean age (SD) was 39.6 years (6.3). Co-morbidities were rare in both groups, and blood pressures were similar amongst pregnant and non-pregnant women (overall mean (SD) first systolic and diastolic blood pressures were 157.4 (20.6)/100.7 (13.6) mm Hg and overall mean (SD) second systolic and diastolic blood pressures were 151.7 (20.1)/98.4 (13.5) mm Hg). However, compared to non-pregnant women, pregnant women had a higher rate of newly diagnosed hypertension (65.2% versus 54.4% p = 0.02) and lower baseline walk-in treatment (32.1% versus 42.1%, p = 0.03). The control rate was numerically lower among pregnant patients (6.3% versus 10.2%, p = 0.17), but was not statistically significant. Some pregnant patients (8.3%) were on medications contraindicated in pregnancy, and none of the pregnant women were on aspirin for primary prevention of preeclampsia.ConclusionsThese findings indicate significant gaps in care and important areas for future studies to improve the quality of care and outcomes for pregnant women with hypertension in Nigeria, a country with the highest burden of maternal mortality globally.

Aspirin for primary prevention of cardiovascular disease: What do the current USPSTF guidelines say?

The 2022 US Preventive Services Task Force (USPSTF) recommendation notes that the decision to initiate daily aspirin therapy for primary prevention of cardiovascular disease (CVD) should be made on a case-by-case basis for adults ages 40 to 59 with a 10% or greater 10-year CVD risk. The recommendation applies to those without signs or symptoms of clinically evident CVD who are not at an increased risk of bleeding. Clinicians are encouraged to use their judgment in weighing the risks and benefits of aspirin therapy, while taking patient preference into account for patients ages 40 to 60.

Aspirin deprescribing in primary prevention of cardiovascular disease: a prospective risk-benefit approach.

Current evidence and practice guidelines do not recommend aspirin for primary prevention of cardiovascular disease (CVD). Insufficient all-cause mortality benefits juxtaposed to increased gastrointestinal bleeding rates are well established. Pharmacists are well placed to assess the clinical appropriateness of aspirin in CVD and initiate deprescribing as required with medical colleagues. The aim of this study was to identify medical inpatients taking aspirin for primary prevention of CVD and initiate deprescribing utilising a risk-benefit approach. A single-arm prospective feasibility study of general medicine patients admitted to a major tertiary hospital over 5 weeks (July-August 2020) was conducted. Screened patients were categorised as either taking aspirin for primary or secondary prevention. A 5-year benefit-risk analysis of bleeding and cardiovascular risk was calculated using a validated tool from the Cardiac Society of Australia and New Zealand to guide recommendations. This study screened 277 patients, of which 71 patients were identified as taking aspirin. Ten of these patients (14%) were categorised as taking aspirin for primary prevention and thus were deemed suitable for deprescribing. The analysis showed that aspirin continuance would, on average, increase major bleeding events by 39%, whilst reducing major cardiovascular events by 13.4%. Pharmacists recommended aspirin cessation in seven of the cases identified, and deprescribing was successful in five cases. This study described an impactful pharmacist-led initiative utilising a validated aspirin-specific tool to conduct risk-benefit analysis to reduce potential major bleeding associated with inappropriate aspirin use.

Low Dose Aspirin for Primary Prevention of Adverse Pregnancy Outcome

Background: Pregnancy is associated with various complications such as pre-eclampsia, SGA, preterm birth etc. Low dose aspirin is a possible medication to minimize these adverse outcomes. The aim of this study was to evaluate the use of low dose aspirin for primary prevention of adverse pregnancy outcome. Material Methods: This cross-sectional study was conducted in department of Gynaecology, North Bengal Medical College Hospital, Mirjapur Bkash Hospital, Mirjapur, Tangail, Bangladesh, during the period from June 2021 to August 2022. Total 200 pregnant women were included in this study. Results: In this study, the mean (±SD) age of the study subjects were 25.12 ± 5.49 years and 25.00 ± 4.83 years in LDA group and control group, respectively. There was no statistically significant (p&gt;0.05) difference in age between the groups. The rate of caesarean section was higher in control group (68%) compared to LDA group (59%) but there was no statistically significant (p&gt;0.05) difference among the groups. In our study, 8% pregnant women in LDA group and 19% pregnant women in control group had gestational hypertension, pre-eclampsia was seen in 6% and 13% pregnant women in LDA group and control group, respectively, preterm birth was seen in 8% and 17% pregnant women in LDA group and control group, respectively, SGA was seen in 19% and 32% pregnant women in LDA group and control group, respectively, and fetal distress was seen in 2% pregnant women in both LDA group and control group. There were statistically significant (p&lt;0.05) differences in complications except fetal distress. Mean (±SD) neonatal birth weight was 2.88±1.03 kg and 2.74±0.85 kg in LDA group and control group, respectively and there was no statistically significant (p&gt;0.05) difference. Conclusion: We found that low dose aspirin could significantly reduce the risk of adverse outcomes, especially for pre-eclampsia, SGA and preterm birth.