Aspirin For Primary Prevention Research Articles

WITHDRAWN: Adherence to European guidelines for the use of aspirin in primary health care

The Publisher regrets that this article is an accidental duplication of an article that has already been published, 10.1016/j.repc.2022.03.007. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal

TIPS to decide whether to prescribe aspirin for the primary prevention of cardiovascular events in chronic kidney disease

Aspirin effectively prevents subsequent cardiovascular events. A post hoc subgroup analysis of the International Polycap Study 3 (TIPS-3) trial suggests that patients with chronic kidney disease might also benefit from aspirin for primary prevention. We consider the merits of doing so in practice.

Aspirin in diabetic patients at primary prevention: insights of the VITAL cohort

PurposeAspirin use among patients with diabetes in primary prevention is still a matter of debate. We aimed to evaluate the potential cardiovascular risk benefit of aspirin in primary prevention, using data from a contemporary cohort.MethodsRetrospective analysis of the VITAL cohort with > 20,000 individuals at primary prevention who were followed for a median of 5.3 years. The population was evaluated according to the baseline diabetes status, and then aspirin use was evaluated among diabetic patients. Cox regression models were used to estimate the risks of mortality and cardiovascular outcomes. The estimates were reported using adjusted hazard ratio (HR) and 95% confidence intervals (95%CI).ResultsDiabetic patients (n = 3549; 13.7%) showed to increase the risk of all-cause mortality (HR 1.61, 95%CI 1.33–1.94), and major adverse cardiovascular events (MACE) (HR 1.36 95%CI 1.11–1.68) than non-diabetic population. Diabetic patients taking aspirin were older, more frequently man, hypertensive, current users of statins, and current smokers compared with diabetic patients who did not use aspirin at baseline. There was no difference between diabetic aspirin users and non-users regarding all-cause mortality (HR 0.80, 95%CI 0.59, 1.10), MACE (HR 0.92, 95%CI 0.64, 1.33), coronary heart disease (HR 0.98, 95%CI 0.67, 1.43), or stroke (HR 0.87, 95%CI 0.48, 1.58).ConclusionsThe VITAL data confirmed diabetes as an important risk factor for cardiovascular events in a contemporary cohort but did not show cardiovascular benefits of aspirin in primary prevention among people with diabetes who were shown to be at higher risk of cardiovascular events.

Adherence to European guidelines for the use of aspirin in primary health care

Introduction and objectivesCardiovascular disease remains a leading cause of global morbidity and mortality. The administration of low doses of aspirin in secondary prevention of atherosclerotic cardiovascular disease (ASCVD) has been clearly established. However, the most recent guidelines do not recommend aspirin in primary prevention, reserving it for high-risk patients and after a risk/benefit assessment. The aim of this study was to assess adherence to European guidelines for the use of aspirin in primary and secondary prevention of ASCVD in primary health care. MethodsThe study population consisted of individuals aged >50 years registered at two primary health care units without (primary prevention) and with previous ASCVD events (secondary prevention). ResultsWe studied a total of 1262 individuals, 720 in primary prevention and 542 in secondary prevention. A total of 61 individuals (8.5%) were under aspirin therapy in primary prevention, most of them taking 150 mg/day (57%). In secondary prevention, 195 patients (27%) were receiving aspirin only, most taking 150 mg/day (52%), and 166 patients (31%) were not under any antithrombotic or anticoagulant therapy. The 100 mg dosage was predominant in patients with ischemic heart disease with (64%) and without (64%) angina, as well as those with myocardial infarction (61.5%) and peripheral vascular disease (62%). ConclusionsIn this study, the prevalence of aspirin use in primary prevention was 8.5%. We found that 30% of patients were not taking either antithrombotic or anticoagulation therapy in secondary prevention. In both primary and secondary prevention, the 150 mg dosage was predominant.

What Is the Role of Aspirin in Primary Prevention in Patients With Elevated Lp(a)?

What Is the Role of Aspirin in Primary Prevention in Patients With Elevated Lp(a)?

Frequency of Pre-Eclampsia in High-Risk Pregnant Women Treated with Low Dose Aspirin (LDA) Presenting in Tertiary Care Hospital

Objective: To determine the frequency of pre-eclampsia among high-risk pregnant women treated with low dose aspirin (LDA) presenting in a tertiary care hospital. Study design: Descriptive study Duration of study: Six months from 20-02-2018 to 19-08-2018. Setting: Study was conducted in OPD of Obstetrics and Gynaecology Department, Combined Military Hospital, Lahore National University of Medical Sciences NUMS Material and methods: A total of 175 patients were included in the study. Pregnant females diagnosed as high risk were treated with low dose aspirin (75 mg) daily started at 12 to 16 weeks of gestation till the end of pregnancy. 24 hours urine protein test was done for patients with B.P. >140/90mmHg after 20 weeks of gestation and if at least 300mg protein was present in 24 hours urine then patient was labeled as pre-eclamptic. Results: Patients ranged between 20-35 years of age with mean age of 25.9±3.6 years. Mean gestational age was 14.4±1.1 weeks and mean BMI was 27.3±4.3 kg/m2. Pre-eclampsia developed in 27 patients (15.4%). Obesity found in 53 patients (30.3%). There were 27 (15.4%) primigravida and 148 (84.6%) multigravida patients. Conclusion: In conclusion, low dose aspirin is effective in prevention of preeclampsia in high-risk patients. Indications for aspirin in primary prevention are a matter of debate, but recent publications suggest a strategy based on first-trimester screening of preeclampsia (with clinical parameters, biomarkers and uterine artery Doppler measurements) and aspirin administration to high-risk patients. Keywords: Aspirin, High risk pregnancy, Pre-eclampsia

Aspirin in primary prevention and the risk of heart failure: a systematic review and meta-analysis of controlled trials.

Aspirin in primary prevention and the risk of heart failure: a systematic review and meta-analysis of controlled trials.

Aspirin for primary prevention of cardiovascular disease in women.

Aspirin use for primary prevention of cardiovascular disease is controversial. Low-dose aspirin may be considered for primary prevention in women on an individualized basis for those aged 40 to 59 years with a 10-year cardiovascular risk of 10% or more and without increased bleeding risk. Low-dose aspirin for primary prevention is not advised for low-risk women or women aged 60 years or older.

The Prevalence Of Aspirin Use As A Primary Prevention In Hypertensive Patients In Tikrit City

The aspirin use for secondary prevention of cardiovascular disease (CVD) is strongly supported and is well established but its use for primary prevention of cardiovascular events is a source of major debate due to that persons without a previous history of CVD are less likely to have future cardiovascular events, so there is unclear balance between benefits of aspirin to decrease the risk as primary prevention and harms of increase risk of both gastrointestinal bleeding and hemorrhagic stroke. This was reflected in international trails and guidelines. In this study, to balance the risk and benefit of using aspirin for primary prevention of CVD , and depend on trials and guidelines , the using of aspirin is more beneficial and indicated in patients with high ASCVD risk (e.g., as calculated by ASCVD risk score ((which used to calculate the 10 years risk of major coronary events in adults)) as >10% , or depending on the presence of certain ASCVD risk factors) , in patients with age between 40-70 and low risk of bleeding. This study aimed to estimate the prevalence of aspirin use in hypertensive patients for primary prevention of cardiovascular diseases. One hundred fifty hypertensive patients (75 male) and (75 female) attending the outpatient clinic in Saladin general hospital in Tikrit city were included in this study from January 2018 to December 2019. Considering these parameters (age, total cholesterol level, , systolic blood pressure (BP), high density lipoprotein cholesterol (HDL), and smoking) in every patients.

The Use of Aspirin Increases the Risk of Major Adverse Cardiac and Cerebrovascular Events in Hypertensive Patients with Obstructive Sleep Apnea for the Primary Prevention of Cardiovascular Disease: A Real-World Cohort Study

(1) Background: Hypertensive patients with obstructive sleep apnea (OSA) are at high risk for cardiovascular diseases (CVDs), and the utility of aspirin for primary cardiovascular prevention in this population remains uncertain. (2) Methods: In this retrospective cohort study using data from the Urumchi Hypertension Database (UHDATA), hypertensive patients older than 18 years old with a first-time diagnosis of OSA were divided into three groups depending on aspirin history. Major adverse cardiac and cerebrovascular events (MACCE) were the primary outcome. Secondary outcomes included MACCE components, ischemic events, cardiac events, cerebrovascular events, and gastrointestinal bleeding risk. The inverse probability of treatment weighting (IPTW) method was used to balance the confounding factors among the groups, and the Cox proportional hazards model was used to calculate the hazard ratio (HR) and 95% confidence interval (CI). (3) Results: In persistent aspirin users, the risk of MACCE events (HR 2.11, 95%CI 1.23-3.63), ischemic events (HR 2.58, 95%CI 1.42-4.69), cerebrovascular events (HR 2.55, 95%CI 1.44-4.51), and non-fatal cerebral infarction (HR 3.14, 95%CI 1.69-5.84) was significantly elevated. (4) Conclusions: Continuous aspirin use increases the incidence of cardiovascular adverse events in hypertensive patients with OSA receiving aspirin for primary prevention of cardiovascular disease.

Deprescription of aspirin for primary prevention is uncommon at discharge in hospitalised patients with gastrointestinal bleeding.

Guidelines recommend against aspirin for primary prevention of cardiovascular events in individuals with a history of gastrointestinal bleeding (GIB). It is unknown how often patients on primary prevention aspirin hospitalised with GIB have aspirin discontinued at discharge. To determine the rate of aspirin deprescription and explore long-term outcomes in patients taking aspirin for primary prevention of cardiovascular events. We evaluated all patients hospitalised at Yale-New Haven Hospital between January 2014 and October 2021 with GIB who were on aspirin for primary prevention. Our primary endpoint was the frequency of aspirin deprescription at discharge. Our secondary endpoints were post-discharge hospitalisations for major adverse cardiovascular events (MACE) or GIB. Time-to-event analysis was performed using Kaplan-Meier curves and the log-rank test. We identified 320 patients with GIB on aspirin for primary prevention: median age was 72 (interquartile range [IQR] 61-81) years and 297 (92.8%) were on aspirin 81 mg daily. Only 25 (9.0%) patients surviving their hospitalisation were deprescribed aspirin at discharge. Among 260 patients with follow-up (median 1103 days; IQR 367-1670), MACE developed post-discharge in 2/25 (8.0%) with aspirin deprescription versus 37/235 (15.7%) with aspirin continuation (log-rank p=0.28). 0/25 patients with aspirin deprescription had subsequent hospitalisation for GIB versus 17/235 (7.2%) who continued aspirin (log-rank p=0.13). Aspirin for primary cardiovascular prevention was rarely deprescribed at discharge in patients hospitalised with GIB. Processes designed to ensure appropriate deprescription of aspirin are crucial to improve adherence to guidelines, thereby improving the risk-benefit ratio in patients at high risk of subsequent GIB hospitalisations with minimal increased risk of MACE.

Abstract 11374: Aspirin for Primary Prevention of Cardiovascular Events in Patients With Elevated Lipoprotein(a): The Multi-Ethnic Study of Atherosclerosis

Introduction: There is a lack of effective therapies for reducing risk in people with elevated Lp(a), especially for primary prevention. We aimed to evaluate the association between aspirin use and cardiovascular events (CVD) in people with elevated Lp(a). Methods: We performed a prospective cohort study using data from participants from the Multi-Ethnic Study of Atherosclerosis (MESA) who were free of baseline cardiovascular disease. We matched aspirin users and non-users using a propensity score based on CVD risk factors. We then evaluated the association between aspirin use and coronary heart disease (CHD) events (CHD death, non-fatal myocardial infarction) stratified by baseline Lp(a) level (above and below 50 mg/dL) using Cox proportional hazards models with adjustment for CVD risk factors. Results: Our study cohort included 6,632 participants, including 1,138 (20%) with Lp(a) >50 mg/dL and 1,592 (24%) with baseline aspirin use. Participants with elevated Lp(a) had a higher burden of CVD risk factors, with a trend toward greater aspirin use (25.7% vs 23.6%, p=0.10) and significantly higher CHD events (9.0% vs 7.3%, p=0.03). After propensity matching, aspirin was associated with a significant reduction in CHD events among those with elevated Lp(a) (HR 0.54, 95% CI 0.32-0.94, p=0.03). Those with Lp(a) >50 mg/dL with aspirin use had similar freedom from CHD as those with Lp(a) ≤50 mg/dL regardless of aspirin use ( Figure ). Conclusions: Aspirin use was associated with a significant reduction in CHD events in participants with elevated Lp(a) without baseline CVD. These results are hypothesis generating and require confirmation in studies with randomization of aspirin use.

Aspirin in primary cardiovascular prevention - a 2022 update

In the context of secondary prevention, the efficacy of aspirin in reducing cardiovascular events is widely acknowledged. However, its use for primary prevention is still debated because of uncertain data regarding the risk-benefit ratio. Despite the reduction in atherothrombotic events, almost all randomized clinical trials and meta-analyses have failed to demonstrate a net clinical benefit, as cardiovascular outcome improvement was counterbalanced by increased bleeding. We have, however, to acknowledge that, within the population eligible for primary prevention, cardiovascular risk distribution is extremely heterogeneous. Using data obtained from the most recent trials, we performed a meta-regression of benefits and risks associated with aspirin related to 10-year risk of major adverse cardiovascular events (MACEs). We are thus proposing a tailored approach to find the proper patient category to treat with aspirin in primary prevention. In patients <70 years old with an optimal control of cardiovascular risk factors, physicians should carefully evaluate individual MACE risk and make a therapeutic decision accordingly, also considering bleeding risk and patient preference. The results of net clinical benefit analysis of aspirin therapy suggest that patients with intermediate-high cardiovascular risk (10-year MACE risk >10%) without a prohibitive bleeding risk may represent the target population, since in these patients the reduction in atherothrombotic events overcomes the induced excess of bleeding. Antiplatelet therapy benefits also appear to be amplified by the simultaneous administration of gastroprotective agents and treatment of other cardiovascular risk factors, such as dyslipidemia and hypertension.

Aspirin for Primary Prevention of Cardiovascular Events in Relation to Lipoprotein(a) Genotypes

BackgroundThe role of aspirin in reducing lipoprotein(a)-mediated atherothrombotic events in primary prevention is not established. ObjectivesThis study sought to assess whether low-dose aspirin benefits individuals with elevated plasma lipoprotein(a)-associated genotypes in the setting of primary prevention. MethodsThe study analyzed 12,815 genotyped individuals ≥70 years of age of European ancestry and without prior cardiovascular disease events enrolled in the ASPREE (ASPirin in Reducing Events in the Elderly) randomized controlled trial of 100 mg/d aspirin. We defined lipoprotein(a)-associated genotypes using rs3798220-C carrier status and quintiles of a lipoprotein(a) genomic risk score (LPA-GRS). We tested for interaction between genotypes and aspirin allocation in Cox proportional hazards models for incidence of major adverse cardiovascular events (MACE) and clinically significant bleeding. We also examined associations in the aspirin and placebo arms of the trial separately. ResultsDuring a median 4.7 years (IQR: 3.6-5.7 years) of follow-up, 435 MACE occurred, with an interaction observed between rs3798220-C and aspirin allocation (P = 0.049). rs3798220-C carrier status was associated with increased MACE risk in the placebo group (HR: 1.90; 95% CI: 1.11-3.24) but not in the aspirin group (HR: 0.54; 95% CI: 0.17-1.70). High LPA-GRS (vs low) was associated with increased MACE risk in the placebo group (HR: 1.70; 95% CI: 1.14-2.55), with risk attenuated in the aspirin group (HR: 1.41; 95% CI: 0.90-2.23), but the interaction was not statistically significant. In all participants, aspirin reduced MACE by 1.7 events per 1,000 person-years and increased clinically significant bleeding by 1.7 events per 1,000 person-years. However, in the rs3798220-C and high LPA-GRS subgroups, aspirin reduced MACE by 11.4 and 3.3 events per 1,000 person-years respectively, without significantly increased bleeding risk. ConclusionsAspirin may benefit older individuals with elevated lipoprotein(a) genotypes in primary prevention.

USPSTF concludes daily aspirin may hurt more than help, especially for older adults

USPSTF concludes daily aspirin may hurt more than help, especially for older adults

Aspirin for Primary Prevention of Cardiovascular Diseases: "WALTZ" with the Evidence.

Purpose of ReviewIn this review article, a detailed analysis of the current literature is provided, along with a “glimpse” into what the future holds for aspirin in the context of primary prevention.Recent FindingsThe role of aspirin in primary prevention of cardiovascular diseases (CVD) has been extensively evaluated; however, the results provided over the years have been controversial. Identification of individual subgroups who may benefit from aspirin administration at an acceptable risk of bleeding complications is of paramount importance. Additionally, questions emerge at everyday clinical practice regarding the optimal use of aspirin in different phenotypes of patients due to age, sex, obesity status, frailty and diabetes mellitus.SummaryUntil further data become available, the effective management of the well-established CV risk factors constitutes the milestone in the primary prevention of CVD. Moreover, based on the available evidence, the beneficial addition of aspirin in the modern era of lifestyle and pharmacological interventions for primary CVD prevention remains largely undetermined and further research is needed.

USPSTF updates recommendations on aspirin and CVD

New evidence is reshaping the role of low-dose aspirin in primary prevention. More selective decisions are now urged.

Aspirin for Primary Stroke Prevention; Evidence for a Differential Effect in Men and Women

Background:The use of aspirin for primary prevention of cardiovascular events in men and women remains controversial. Our study aimed to investigate the role of aspirin in primary stroke prevention in men and women and the effect of aspirin on risk of ischemic stroke in patients with covert cerebral small vessel disease (ccSVD).MethodsWe performed systematic searches of the PubMed, and Cochrane Library databases, covering the period from the inception of each database to May 2021. The incidence of any ischemic stroke (IS) or hemorrhagic stroke (HS) was the main outcome. The incidence of stroke overall, both ischemic (IS) and hemorrhagic (HS), was the main outcome.ResultsFrom 531 abstracts, 11 randomized control trials which assessed primary prevention of cardiovascular events in men and women were included. Only one study assessed the risk of aspirin in people with ccSVD. In women, there was significant decrease in the risk of stroke (OR 0.85 [95% CI 0.73, 0.99], p = 0.03) and IS (OR 0.76 [0.63, 0.93], p = 0.008) with aspirin compared to placebo while no increase in the risk of HS was found (OR 1.78 [0.61, 5.19], p = 0.29). In men, aspirin did not affect the risk of stroke (OR 1.13 [0.97, 1.31], p = 0.12) and IS (OR 0.94 [0.67, 1.32], p = 0.72) but increased the risk of HS with borderline statistical significance (OR 1.99 [0.99, 4.03], p = 0.05) compared to placebo. Aspirin significantly increased major bleedings in both sexes (p < 0.05). We found no evidence to support the use of aspirin in patients with ccSVD.ConclusionOur meta-analysis suggests aspirin is effective in primary prevention of stroke and IS in women with no clear increased risk of HS. However, it was associated with an overall increased risk of bleeding. Aspirin is not recommended in ccSVD.

Benefits and Risks Associated with Low-Dose Aspirin Use for the Primary Prevention of Cardiovascular Disease: A Systematic Review and Meta-Analysis of Randomized Control Trials and Trial Sequential Analysis.

The role of aspirin in cardiovascular primary prevention remains controversial. Moreover, evidence for the potential benefits of aspirin in patients with high cardiovascular risk remains limited. The aim of this study was to explore the role of low-dose aspirin in primary prevention. The PubMed, EMBASE, Cochrane Library, and ClinicalTrials.gov databases were searched for randomized clinical trials (RCTs) from the date of inception to August 2021. The efficacy outcomes were major adverse cardiovascular events (MACE), myocardial infarction (MI), ischemic stroke (IS), all-cause mortality, and cardiovascular mortality, whereas safety outcomes were major bleeding, intracranial hemorrhage, and gastrointestinal (GI) bleeding. Subgroup analyses were based on different cardiovascular risks and diabetes statuses. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using the fixed- and random-effects models, and trial sequential analysis (TSA) was conducted to determine the robustness of the results. A total of 10 RCTs fulfilled the inclusion criteria. The use of aspirin was associated with a significant reduction in the risk of MACE (RR 0.89, 95% CI 0.84-0.93), MI (RR 0.86, 95% CI 0.78-0.95), and IS (RR 0.84, 95% CI 0.76-0.93); however, aspirin also increased the risk of safety outcomes, i.e. major bleeding (RR 1.42, 95% CI 1.26-1.60), intracranial hemorrhage (RR 1.33, 95% CI 1.11-1.59), and GI bleeding (RR 1.91, 95% CI 1.44-2.54). Subgroup analyses revealed that in the absence of a statistically significant interaction, a trend toward a net benefit of lower incidence of cardiovascular events (number needed to treat of MACE: high risk: 682 vs. low risk: 2191) and lesser risk of bleeding events (number needed to harm of major bleeding: high risk: 983 vs. low risk: 819) was seen in the subgroup of high cardiovascular risk. Meanwhile, the greater MACE reduction was also detected in the high-risk group of diabetes or nondiabetes patients. Furthermore, a post hoc subgroup analysis indicated a significant rate reduction in patients aged ≤70 years but not in patients aged >70 years. TSA confirmed the benefit of aspirin for MACE up to a relative risk reduction of 10%. The current study demonstrated that the cardiovascular benefits of low-dose aspirin were equally balanced by major bleeding events. In addition, the potential beneficial effects might be seen in the population ≤70 years of age with high cardiovascular risk and no increased risk of bleeding.

MO201: Effects of Aspirin in Primary Prevention of Cardiovascular (CV) Disease in People with Chronic Kidney Disease (CKD): Results of the TIPS3 Trial

Abstract BACKGROUND AND AIMS Subjects with CKD carry a high (CV) risk. Whether this risk is blunted by aspirin is controversial. We examined CV outcomes of CKD participants of the TIPS3 trial. METHOD The International Polycap Study3 (TIPS3) randomized people (N = 5713) with and without CKD, but without previous CV disease, to aspirin, aspirin plus polypill, polypill or respective placebo in a factorial design. In 983 participants that were randomized to aspirin or placebo, eGFR was below 60 mL/min/1.73 m2 at baseline (CKD). The primary outcome for this comparison was non-fatal myocardial infarction (MI), non-fatal stroke or CV death. The mean follow-up was 4.6 years. RESULTS In all participants, there were 250 primary MACE outcomes, 116 on aspirin and 134 on placebo (HR 0.86; 95% CI 0.67–1.10). In those with CKD, there were 65 primary MACE outcomes, 26 in the 502 participants on aspirin, 39 in the 481 participants on placebo, HR 0.57 (95% CI 0.34–0.94). Directionally similar results were found for aspirin versus placebo for the secondary outcome all-cause death with 312 events in all participants (HR 0.87; 0.70–1.07) and 82 events in CKD patients (HR 0.64; 0.41–0.99). There was no significant interaction of eGFR &amp;lt;60 mL/min with the treatment effects of aspirin versus placebo. Major and minor bleedings were rare and not different between groups. When aspirin was combined with a polypill (containing atenolol, ramipril, hydrochlorothiazide and simvastatin) and compared to double placebo, in all participants the HR for the MACE outcome was 0.69, 0.50–0.97 and for all-cause death 0.80, 0.59–1.08; in CKD patients the HR was 0.37, 0.18–0.75 for MACE and HR 0.49, 0.29–0.97 for death. CONCLUSION Results suggest that the CV risk in people with CKD may be substantially alleviated with aspirin alone and in combination with a polypill.