Aspirin For Primary Prevention Research Articles

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.

USPSTF Report on Aspirin for Primary Prevention

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Aspirin for Primary Prevention—Time to Rethink Our Approach

Aspirin for Primary Prevention—Time to Rethink Our Approach

Aspirin to target arterial events in chronic kidney disease (ATTACK): study protocol for a multicentre, prospective, randomised, open-label, blinded endpoint, parallel group trial of low-dose aspirin vs. standard care for the primary prevention of cardiovascular disease in people with chronic kidney disease

BackgroundChronic kidney disease (CKD) is a very common long-term condition and powerful risk factor for cardiovascular disease (CVD).Low-dose aspirin is of proven benefit in the secondary prevention of myocardial infarction (MI) and stroke in people with pre-existing CVD. However, in people without CVD, the rates of MI and stroke are much lower, and the benefits of aspirin in the primary prevention of CVD are largely balanced by an increased risk of bleeding.People with CKD are at greatly increased risk of CVD and so the absolute benefits of aspirin are likely to be greater than in lower-risk groups, even if the relative benefits are the same. Post hoc evidence suggests the relative benefits may be greater in the CKD population but the risk of bleeding may also be higher. A definitive study of aspirin for primary prevention in this high-risk group, recommended by the National Institute for Health and Care Excellence (NICE) in 2014, has never been conducted. The question has global significance given the rising burden of CKD worldwide and the low cost of aspirin.MethodsATTACK is a pragmatic multicentre, prospective, randomised, open-label, blinded endpoint adjudication superiority trial of aspirin 75 mg daily vs. standard care for the primary prevention of CVD in 25,210 people aged 18 years and over with CKD recruited from UK Primary Care.Participants aged 18 years and over with CKD (GFR category G1-G4) will be identified in Primary Care and followed up using routinely collected data and annual questionnaires for an average of 5 years. The primary outcome is the time to first major vascular event (composite of non-fatal MI, non-fatal stroke and cardiovascular death [excluding confirmed intracranial haemorrhage and other fatal cardiovascular haemorrhage]). Deaths from other causes (including fatal bleeding) will be treated as competing events. The study will continue until 1827 major vascular events have occurred. The principal safety outcome is major intracranial and extracranial bleeding; this is hypothesised to be increased in those randomised to take aspirin. The key consideration is then whether and to what extent the benefits of aspirin from the expected reduction in CVD events exceed the risks of major bleeding.DiscussionThis will be the first definitive trial of aspirin for primary CVD prevention in CKD patients. The research will be of great interest to clinicians, guideline groups and policy-makers, in the UK and globally, particularly given the high and rising prevalence of CKD that is driven by population ageing and epidemics of obesity and diabetes. The low cost of aspirin means that a positive result would be of relevance to low- and middle-income countries and the impact in the developed world less diluted by any inequalities in health care access.Trial registrationISRCTN: ISRCTN40920200. EudraCT: 2018-000644-26. ClinicalTrials.gov: NCT03796156

An Evaluation of Aspirin Treatment Preferences ORIGINAL INVESTIGATION of Physicians in Hypertensive Patients in Terms of Current Guidelines: A Subgroup Analysis of the ASSOS Trial in Turkey.

BackgroundThe Appropriateness of Aspirin Use in Medical Outpatients: A Multicenter, Observational Study trial has been the largest study ever conducted among patients in Turkey regarding aspirin treatment. In the subgroup analysis of the hypertensive group of the Appropriateness of Aspirin Use in Medical Outpatients: A Multicenter, Observational Study trial, we aimed to evaluate the physicians’ adherence to current guidelines regarding their aspirin treatment preferences. MethodsThe Appropriateness of Aspirin Use in Medical Outpatients: A Multicenter, Observational Study trial is a cross-sectional and multicenter study conducted among 5007 consecutive patients aged ≥18 years. The study population consisted of outpatients on aspirin treatment (80-300 mg). The patient data were obtained from 30 different cardiology clinics of 14 cities from all over Turkey. In this subgroup analysis, patients were divided into 2 groups: the hypertensive group (n = 3467, 69.3%) and the group without hypertension (n = 1540, 30.7%) according to the 2018 European Society of Cardiology/European Society of Hypertension Guidelines for the Management of Arterial Hypertension. ResultsAspirin use for primary prevention was higher in patients with hypertension compared to patients without hypertension [328 (21.3%); 1046 (30.2%); P < .001]. Treatment with a dose of 150 mg aspirin (n = 172, 5%) was mostly preferred by internists for hypertensive patients (n =226, 6.5%); however, a daily dose of 80-100 mg aspirin therapy (n = 1457, 94.6%) was mostly prescribed by cardiologists (n = 1347, 87.5%) for patients without hypertension.ConclusionAspirin was found to be used commonly among patients with hypertension for primary prevention despite the current European Society of Cardiology Arterial Hypertension Guideline not recommending aspirin for primary prevention in patients with hypertension.

Limitations of Observational Studies for Aspirin in Primary Prevention and the Need for Randomized Trials.

Limitations of Observational Studies for Aspirin in Primary Prevention and the Need for Randomized Trials.

Potential Impact of the 2019 ACC/AHA Guidelines on the Primary Prevention of Cardiovascular Disease Recommendations on the Inappropriate Routine Use of Aspirin and Aspirin Use Without a Recommended Indication for Primary Prevention of Cardiovascular Disease in Cardiology Practices: Insights From the NCDR PINNACLE Registry.

Aspirin is recommended in patients with atherosclerotic cardiovascular disease for secondary prevention. In patients without atherosclerotic cardiovascular disease and not at high 10-year risk, there is no evidence aspirin reduces adverse cardiovascular events and it could increase bleeding. The 2019 American College of Cardiology/American Heart Association Guidelines on Primary Prevention of Cardiovascular Disease state that aspirin may be considered for primary prevention (class IIb) in patients 40 to 70 years that are at higher risk of atherosclerotic cardiovascular disease and that routine use of aspirin should be avoided (class III:Harm) for patients >70 years. We examined the frequency of patients on aspirin for primary prevention that would have been considered unindicated or potentially harmful per the recent guideline where aspirin discontinuation may be beneficial. To assess the potential impact, within the National Cardiovascular Disease Registry Practice Innovation and Clinical Excellence Registry, we assessed 855 366 patients from 400 practices with encounters between January 1, 2018 and March 31, 2019, that were receiving aspirin for primary prevention. We defined inappropriate use as the use of aspirin in patients <40 or >70 years and use without a recommended indication as use of aspirin in patients 40 to 70 years with low, borderline, or intermediate 10-year atherosclerotic cardiovascular disease risk. Frequency of inappropriate use and use without a recommended indication were calculated and practice-level variation was evaluated using the median rate ratio. Inappropriate use occurred in 27.6% (193 674/701 975) and use without a recommended indication in 26.0% (31 810/122 507) with significant practice-level variation in inappropriate use (predicted median practice-level rate 33.5%, interquartile range, 24.1% to 40.8%; median rate ratio, 1.71 [95% CI, 1.67-1.76]). Immediately before the 2019 American College of Cardiology/American Heart Association Guidelines on Primary Prevention of Cardiovascular Disease, over one-fourth of patients in this national registry were receiving aspirin for primary prevention inappropriately or without a recommended indication with significant practice-level variation. These findings help to determine the potential impact of guideline recommendations on contemporary use of aspirin for primary prevention.

Meta-Analysis of Aspirin for Primary Prevention of Stroke

Objective: This paper aims to evaluate the safety and efficacy of aspirin in primary stroke prevention by meta-analysis. Methods: By searching PubMed, Cochrane Library, Embase, MEDLINE, Web of Science, CNKI, China Biomedical Literature Database, VIP Database and Wanfang Database, we collected randomized controlled trials on aspirin for primary prevention of stroke. The retrieval time limit is from the establishment of the database to December 2021. Two researchers independently conducted literature search, screening, data extraction and quality evaluation, and Meta-analysis was performed using RevMan 5.3. Results: A total of 19 articles were included, including 220,636 subjects. Meta-analysis results show that long-term preventive use of aspirin can reduce the incidence of stroke [RR = 0.91, 95% CI (0.85, 0.98), P = 0.009], and reduce the incidence of ischemic stroke [RR = 0.84, 95% CI] (0.77, 0.91), P RR = 0.80, 95% CI (0.72, 0.88), P RR = 0.85, 95% CI (0.75, 0.97), P RR = 1.23, 95% CI (1.04, 1.46), P = 0.01] and gastrointestinal bleeding [RR = 1.62, 95% CI (1.35, 1.93), P RR = 0.97, 95% CI (0.93, 1.02), P = 0.20]. Conclusion: Long-term prophylactic use of aspirin can reduce the overall incidence of stroke, but there is also a risk of bleeding. The advantages and disadvantages of aspirin should be fully evaluated and strict screening should be carried out before medication, which can minimize adverse reactions and improve the safety and effectiveness of aspirin in the primary prevention of stroke.

In persons at intermediate risk for CVD, polypills reduce a composite of CV events at 5 y.

Joseph P, Roshandel G, Gao P, et al. Fixed-dose combination therapies with and without aspirin for primary prevention of cardiovascular disease: an individual participant data meta-analysis. Lancet. 2021;398:1133-46. 34469765.

Appraising the contemporary role of aspirin for primary and secondary prevention of atherosclerotic cardiovascular events

ABSTRACT Introduction Although the role of aspirin for primary prevention of atherosclerotic cardiovascular disease (ASCVD) has been disputed, its use in secondary ASCVD prevention is well established. Recent trials of primary prevention do not suggest a significant net benefit with aspirin, whereas accruing evidence supports adopting aspirin-free strategies in the context of potent P2Y12 inhibition for the secondary prevention of selected patients undergoing percutaneous coronary intervention. Areas covered This updated review aims at summarizing and appraising the pharmacological characteristics and the contemporary role of aspirin for the primary and secondary prevention of ASCVD. Expert opinion Recent trials and metanalyses in the context of primary prevention highlighted a modest reduction in ischemic events with aspirin use, counterbalanced by a significant increase in bleeding events. However, ongoing studies on cancer prevention could modify the current paradigm of the unfavorable benefit-risk ratio of aspirin in patients with no overt ASCVD. Conversely, aspirin use is crucial for secondary ASCVD prevention, both in chronic and acute coronary syndromes. Nevertheless, after a brief period of dual antiplatelet therapy, patients at high bleeding risk may benefit from discontinuation of aspirin if a P2Y12 inhibitor is used, hence reducing the bleeding risk with no rebound in thrombotic events.

Low-dose aspirin for primary prevention of adverse pregnancy outcomes in twin pregnancies: an observational cohort study based on propensity score matching

BackgroundSince the effectiveness of low-dose aspirin (LDA) in twin pregnancies is uncertain, we aimed to preliminarily assess whether LDA is beneficial in preventing preeclampsia in twin pregnancies.MethodsThis study is an observational study in two hospitals in China. Among 932 women, 277 in the First Affiliated Hospital of Chongqing Medical University were routinely treated with aspirin (100 mg daily) from 12 to 16 weeks to 35 weeks of gestational age, while 655 in Chongqing Health Center for Women and Children were not taking aspirin during pregnancy. We followed each subject and the individual details were recorded.ResultsLDA significantly reduced the risk of preeclampsia (RR 0.48; 95% CI 0.24–0.95) and preterm birth 34 weeks (RR 0.50; 95% CI 0.29–0.86) and showed possible benefits to lower the rate of SGA babies (RR 0.74; 95% CI 0.55–1.00). Moreover, the risk of postpartum hemorrhage was not increased by LDA (RR 0.89; 95% CI 0.35–2.26).ConclusionsTreatment with low-dose aspirin in twin pregnancies could offer some protection against adverse pregnancy outcomes in the absence of significantly increased risk of postpartum hemorrhage.Trial registrationChinese Clinical Trial Registry (ChiCTR); ChiCTR-OOC-16008203, Retrospectively registered date: April 1st, 2016;

Evaluation of Provider Implementation of the 2019 American College of Cardiology and American Heart Association Aspirin for Primary Prevention Guideline Recommendations for Older People.

Design Retrospective chart review study using electronic medical record data from Inova Health System patients. Setting All cardiology, endocrinology, and primary care outpatient clinics operated by Inova Medical Group (IMG) in Northern Virginia. Participants Participants included were 70 years of age or older and taking aspirin 81 mg as of April 1, 2019. They had completed at least one visit with an IMG provider in primary care, cardiology, or endocrinology clinics between April 1, 2019, and February 17, 2020. Main Outcome Measures The primary outcome of this study was percentage of older people seen by a primary care physician, cardiologist, or endocrinologist since guideline publication who were continued on aspirin for primary prevention. Results The percentage of participants continued on aspirin for primary prevention was 92% versus 8.0% who were discontinued (P < 0.0001). Differences in subgroup analyses based on smoking history, diagnosis of diabetes, or history of venous thromboembolism were not statistically significant. Conclusion There was a significantly greater rate of aspirin continuation versus discontinuation among patients 70 years of age and older in the setting of primary cardiovascular prevention. Based on this result, most primary care physicians, endocrinologists, and cardiologists at this institution have chosen to continue aspirin in older people following the 2019 American College of Cardiology/American Heart Association guideline statement publication.

Should my older adult patients take aspirin for primary prevention of cardiovascular disease?

Should my older adult patients take aspirin for primary prevention of cardiovascular disease?

Low-dose Aspirin for Primary Prevention of Cardiovascular Events in Postmenopausal Women with Type-2 Diabetes: The Prescriptive Approach in the Real World.

Background:The long-term efficacy of low-dose aspirin for primary prevention of cardiovascular (CV) events in postmenopausal women with type-2 diabetes is controversial. Therefore, it is recommended only on an individual basis, recommendation of grade C.Methods:We enrolled 275 consecutive postmenopausal women with type-2 diabetes, without an increased bleeding risk and without preexisting CV disease as coronary artery disease, stroke, and peripheral vascular disease, but with a high risk assessed by score >10%, aged 60–69 years. All were receiving aspirin (75–100 mg daily), aspirin group (AG). 170 postmenopausal women with type-2 diabetes and without preexisting cardiovascular (CV) disease, but not on aspirin treatment, despite a high risk assessed by score >10%, were control group (CG). Mean age was 66 ± 4 years for AG and 65 ± 7 years for CG. Our goal was to identify the prevalence of low-dose aspirin prescriptions in these populations according to different clinical conditions.Results:Women with only high risk were 41/275 (15%) on AG and 72/170 (42.3%) on CG, Chi-squared 41, Odds ratio 0.2, c.i. 95%, P < 0.0001. Women affected by metabolic syndrome were 105/275 (38.1%) on AG and 47/170 (27.6%) on CG, Chi-squared 5.1, Odds ratio 1.6, c.i. 95%, P < 0.02. Women affected by metabolic cardiomyopathy were 111/275 (40.3%) on AG and 44/170 (25.9%) on CG, Chi-squared 8, Odds ratio 1.8, c.i. 95%, P < 0.004. Women affected by diabetic cardiomyopathy were 18/275 (6.6%) on AG and 7/170 (4.2%) on CG, Chi-squared 1.2, Odds ratio 16, c.i. 95%, P < 0.2 n.s.Conclusions:Low-dose aspirin in our population is prescribed preferentially in postmenopausal women with type-2 diabetes when affected by metabolic syndrome or metabolic cardiomyopathy, at the opposite women with only high risk have lower chance to receive aspirin.

Highlights of Cardiovascular Disease Studies Presented at the 2021 European Society of Cardiology Congress.

This review highlights select studies presented at the virtual 2021 European Society of Cardiology (ESC) Congress. Reviewed studies assess single photon emission computed tomography, positron emission tomography, magnetic resonance imaging in coronary artery disease (PACIFIC-II); empagliflozin in heart failure with preserved ejection fraction (EMPEROR-Preserved); dapagliflozin in chronic heart failure (DAPA-HF); proprotein convertase subtilisin/kexin type 9 inhibitor and its lipid lowering effects (NATURE-PCSK9); fixed-dose combination therapies with or without aspirin in primary prevention; overview of contrasting results between REDUCE-IT versus STRENGTH trials; Quadruple UltrA-low-dose tReaTment for hypertension (QUARTET); evolocumab and changes in plaque composition on optical coherence tomography (HUYGENS); and low-dose rivaroxaban during the acute phase of acute coronary syndrome (H-REPLACE). Research presented at the 2021 ESC Congress shows promise in reducing burden of cardiovascular disease and reinforces the value of cardiovascular disease prevention.

Usefulness of a new risk score in identifying patients with CML at increased risk of cardiovascular toxicities

Abstract Background Anti-BCR-ABL tyrosine kinase inhibitors (TKIs) dramatically improved the prognosis of patients with Chronic Myeloid Leukemia (CML) however they have been associated with cardiovascular (CV) complications. Purpose The primary aim of our study was to compare the usefulness of two different tools to stratify the risk of developing cardiovascular adverse events in haematology patients treated with ponatinib or nilotinib. Methods A real-life retrospective observational study was carried out on 58 patients (32 M, 26 W; mean age ± SD: 59±15) affected by CML treated with TKIs for a median period of 43±31 months. Patients were divided in groups according to CV risk estimated with SCORE and the 2020 CV risk assessment proposed by the Cardio-Oncology Study Group of the ESC/ICOS. Cardiac evaluation and echocardiogram were performed in all patients. The recorded CV adverse events were: myocardial ischemia, peripheral vascular diseases, new-onset or progression of preexisting carotid atherosclerosis, arterial hypertension, arrhythmias. Results According to SCORE, 46% of patients were at high-very high risk (group A1) and 54% at low-moderate risk (group B1). Applying the ESC/ICOS risk stratification tools, 60% were at high-very high risk (group A2) and 40% at low-medium risk (group B2). 21 CV adverse events were observed. CV adverse events were significantly more frequent in group A1 than group B1 (p value = 0,0003) when considered overall, they were significantly more frequent in group A2 than group B2 either overall (p=0,0004) or considered individually (myocardial ischemia: p=0,01; peripheral arterial disease: p=0,03). See Table 1. Moreover, the ESC/ICOS risk stratification tools was significantly more sensitive than SCORE (p=0,0004) in identifying patients at higher risk of cardiovascular toxicity. See Table 2. No patients treated with Ponatinib showed CV adverse events during follow up. It is worth of notice that all patients before starting treatment underwent cardio-oncological evaluation, risk factors correction and preventive treatment with aspirin. They also were treated with the lowest dose of TKI. None of the patients treated with nilotinib over 4 years and with multiple lines of therapy, experiencing adverse events, received aspirin in primary prevention. Conclusions Our study shows that the ESC/ICOS risk stratification tools is very sensitive and more performing than SCORE for risk stratification of cardiotoxicity in haematology patients treated with TKIs. It also suggests that baseline CV risk assessment, CV risk factors correction and preventive treatment with aspirin aid in reducing CV adverse events in patients treated with ponatinib. Funding Acknowledgement Type of funding sources: None. Table 1Table 2

Would You Recommend Aspirin to This Patient for Primary Prevention of Atherosclerotic Cardiovascular Disease? : Grand Rounds Discussion From Beth Israel Deaconess Medical Center.

Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of death in the United States. Reducing ASCVD risk through primary prevention strategies has been shown to be effective; however, the role of aspirin in primary prevention remains unclear. The decision to recommend aspirin has been limited by the difficulty clinicians and patients face when trying to balance benefits and harms. In 2016, the U.S. Preventive Services Task Force addressed this issue by determining the risk level at which prophylactic aspirin generally becomes more favorable, recommending aspirin above a risk cut point (>10% estimated ASCVD risk). In 2019, the American College of Cardiology and the American Heart Association issued a guideline on the primary prevention of CVD that recommends low-dose aspirin might be considered for the primary prevention of ASCVD among select adults aged 40 to 70 years who are at higher ASCVD risk but not at increased risk for bleeding. Here, 2 experts discuss how to apply this guideline in general and to a patient in particular while answering the following questions: How do you assess ASCVD risk, and what is the role, if any, of the coronary artery calcium score?; At what risk threshold of benefits and harms would you recommend aspirin or not?; and How do you help a patient come to a decision about starting or stopping aspirin therapy?

Misuse of Aspirin and Associated Factors for the Primary Prevention of Cardiovascular Disease.

Background: The value of aspirin for primary prevention continues to be debated. Data showing whether aspirin use for primary prevention adheres to established guidelines in real world practice are sparse.Methods: A total of 13,104 patients without cardiovascular diseases (CVD) were selected from the DYS-lipidemia International Study of China, a national survey of patients with dyslipidemia in 2012. The CVD risk of the participants were calculated using the 10-year risk of Ischemic Cardiovascular Diseases model. The misuse of aspirin for primary prevention was defined as having CVD risk <10% with daily aspirin. Multivariate logistic regression models were used to explore risk factors associated with aspirin misuse.Results: The proportion of the patients categorized as low, moderate and high risk for CVD were 52.9, 21.6, and 25.4% respectively. The misuse frequency of aspirin was 31.0% (2,147/6,933) in patients with low risk. The misuse of aspirin increased with aging for both men and women. In the multivariate analysis, the independent risk factors associated with aspirin misuse were hypertension, diabetes mellitus, a family history of premature CVD, and elderly age. Level of total cholesterol is negatively associated with aspirin misuse. Patients from low level hospitals are more likely to be taking aspirin inappropriately. Results remained consistent after including 2,837 patients having 10-year risk for CVD between 10 and <20%.Conclusion: The misuse of aspirin for primary prevention is common in patients having CVD risk <10%. There are important opportunities to improve evidence-based aspirin use for the primary prevention of CVD in Chinese patients.Clinical Trial Registration:https://clinicaltrials.gov/, identifier [NCT01732952].