Aspirin Use For Secondary Prevention Research Articles

Redefining the Roles of Aspirin across the Spectrum of Cardiovascular Disease Prevention.

Even before its role in platelet inhibition was fully characterized in the 1980s, aspirin had been incorporated into the cardiovascular disease care algorithm. Early trials examining its use in unstable angina and acute myocardial infarction revealed evidence of its protective role in the secondary prevention of atherosclerotic cardiovascular disease (ASCVD). Large trials assessing use in the primary prevention setting and optimal dosing regimens were studied in the late 1990s and early 2000s. As a cornerstone of cardiovascular care, aspirin was incorporated into primary and secondary ASCVD prevention guidelines in the United States and mechanical heart valve guidelines. However, in recent years, with significant advances in medical and interventional ASCVD therapies, scrutiny has been placed on the bleeding profile of aspirin, and guidelines have adapted to new evidence. Updates in primary prevention guidelines reserve aspirin only for patients at higher ASCVD risk and low bleeding risk - though questions remain in ASCVD risk assessment as risk-enhancing factors have proven difficult to incorporate on a population level. New thoughts regarding aspirin use in secondary prevention - especially with the concomitant use of anticoagulants - have altered recommendations as additional data accrued. Finally, a recommendation for aspirin and vitamin K antagonists with mechanical heart valves has been modified. Despite aspirin losing a foothold in cardiovascular care, new evidence has strengthened claims for its use in women at high risk for preeclampsia.

Aspirin for Secondary Prevention of Cardiovascular Disease in 51 Low-, Middle-, and High-Income Countries

Aspirin is an effective and low-cost option for reducing atherosclerotic cardiovascular disease (CVD) events and improving mortality rates among individuals with established CVD. To guide efforts to mitigate the global CVD burden, there is a need to understand current levels of aspirin use for secondary prevention of CVD. To report and evaluate aspirin use for secondary prevention of CVD across low-, middle-, and high-income countries. Cross-sectional analysis using pooled, individual participant data from nationally representative health surveys conducted between 2013 and 2020 in 51 low-, middle-, and high-income countries. Included surveys contained data on self-reported history of CVD and aspirin use. The sample of participants included nonpregnant adults aged 40 to 69 years. Countries' per capita income levels and world region; individuals' socioeconomic demographics. Self-reported use of aspirin for secondary prevention of CVD. The overall pooled sample included 124 505 individuals. The median age was 52 (IQR, 45-59) years, and 50.5% (95% CI, 49.9%-51.1%) were women. A total of 10 589 individuals had a self-reported history of CVD (8.1% [95% CI, 7.6%-8.6%]). Among individuals with a history of CVD, aspirin use for secondary prevention in the overall pooled sample was 40.3% (95% CI, 37.6%-43.0%). By income group, estimates were 16.6% (95% CI, 12.4%-21.9%) in low-income countries, 24.5% (95% CI, 20.8%-28.6%) in lower-middle-income countries, 51.1% (95% CI, 48.2%-54.0%) in upper-middle-income countries, and 65.0% (95% CI, 59.1%-70.4%) in high-income countries. Worldwide, aspirin is underused in secondary prevention, particularly in low-income countries. National health policies and health systems must develop, implement, and evaluate strategies to promote aspirin therapy.

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.

Aspirin for cardiovascular disease prevention among adults in the United States: Trends, prevalence, and participant characteristics associated with use

ObjectiveAspirin has been widely utilized over several decades for atherosclerotic cardiovascular disease (ASCVD) prevention among adults in the United States. We examined trends in aspirin use among adults aged ≥40 years from 1998 to 2019 and assessed factors associated with its use for primary and secondary ASCVD prevention. MethodsUsing 1998–2019 Behavioral Risk Factor Surveillance System data, we obtained weighted prevalence of aspirin use among adults aged ≥40 years for each year and examined trends in use over this period. Using multivariable logistic regression and utilizing data from 54,388 respondents aged ≥40 years in the 2019 data, we assessed factors associated with aspirin use for secondary prevention and for primary prevention stratified by the number of traditional ASCVD risk factors reported (hypertension, diabetes mellitus, high cholesterol, overweight/obesity, and cigarette smoking). ResultsAspirin use prevalence increased from 29.0%(95%CI, 27.9%-30.2%) in 1998 to 37.5%(36.9%-38.0%) in 2009. However, use has slightly declined over the last decade: 35.6%(34.6%-36.6%) in 2011 to 33.5%(32.5%-34.6%) in 2019. In 2019, among respondents without cardiovascular disease (CVD), 27.5%(26.4%-28.6%) reported primary prevention aspirin use while 69.7%(67.0%-72.2%) of respondents with CVD reported secondary prevention aspirin use. Of concern, 45.6%(43.5%-47.7%) of adults aged ≥70 years without CVD reported primary prevention aspirin use. Additionally, among individuals without any self-reported traditional ASCVD risk factor, males (adjusted odds ratio(aOR):1.60, 95%CI:1.12–2.27), persons aged ≥70 years (aOR:3.22, 95%CI:2.27–4.55), and individuals with healthcare coverage (aOR:2.28, 95%CI:1.17–4.44) had higher odds of primary prevention aspirin use compared to females, persons aged 40–69 years, and individuals without healthcare coverage, respectively. Females were less likely than males to report secondary prevention aspirin use (aOR:0.64, 95%CI:0.50–0.82). ConclusionAspirin use has slightly declined over the last decade. A significant proportion of adults aged ≥70 years reported primary prevention aspirin use in 2019. Since current guidelines do not recommend primary prevention aspirin use among adults aged ≥70 years, such use should be discouraged.

OP-131 - Appropriateness of Aspirin Use in Medical Outpatients: A Multicenter, Observational Study (Assos Trial)

Objective: Although the benefit of aspirin use for secondary prevention is well established, its role in the primary prevention of cardiovascular diseases remains controversial. Differences in primary prevention guidelines may lead to underuse of aspirin in high-risk patients and overuse in low-risk patients. This study aims to describe the demographic characteristics and current status of the aspirin use for primary and secondary prevention of cardiovascular diseases in a large, multicenter nationwide study.

Aspirin Use and Mortality in Two Contemporary US Cohorts.

Daily aspirin use has been recommended for secondary prevention of cardiovascular disease, but its use for primary prevention remains controversial. We followed 440,277 men and women from the NIH-AARP Diet and Health Study (ages 50-71) and the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (ages 55-74) for mortality for 13 years on average. Frequency of aspirin use was ascertained through self-report, and cause of death by death certificates. We calculated multivariate hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality using Cox proportional hazards models for each cohort and combined by meta-analysis. We found a consistent U-shaped relationship between aspirin use and mortality in both studies, with differential risk patterns for cardiovascular mortality by disease history. Among individuals with a history of cardiovascular disease, daily aspirin use was associated with reduced cardiovascular mortality [HR = 0.78 (95% CI, 0.74, 0.82)]. However, among those without a previous history, we observed no protection for daily aspirin users [HR = 1.06 (1.02, 1.11)], and elevated risk of cardiovascular mortality for those taking aspirin twice daily or more [HR = 1.29 (1.19, 1.39)]. Elevated risk persisted even among participants who lived beyond 5 years of follow-up and used aspirin without other nonsteroidal antiinflammatory drugs [HR = 1.31 (1.17, 1.47)]. Results from these 2 large population-based US cohorts confirm the utility of daily aspirin use for secondary prevention of cardiovascular mortality; however, our data suggest that caution should be exercised in more frequent use, particularly among individuals without a history of cardiovascular disease.

A Critical Appraisal of Aspirin in Secondary Prevention: Is Less More?

Aspirin represents the sine qua non for antiplatelet pharmacotherapy in patients with cardiovascular diseases because of its well-established role in secondary prevention and its widespread availability and affordability. Historical studies, conducted in an era that bears little resemblance to contemporary clinical practice, demonstrated large reductions in thrombotic risk when aspirin was compared with placebo, thus forming the evidence base promulgated in practice guidelines and recommendations. P2Y12 inhibitors have mostly been studied in addition to aspirin; dual-antiplatelet therapy proved superiority compared with aspirin monotherapy for the prevention of ischemic events, despite increased bleeding risks. An alternative approach currently under investigation includes evaluation of single-antiplatelet therapy with P2Y12 inhibitors alone versus dual-antiplatelet therapy after acute coronary syndromes or coronary stent implantation. As the availability of more effective antiplatelet agents increases, it is time to revisit the existing and long-standing paradigm supporting aspirin use for secondary prevention of atherothrombotic events. Ongoing trials will provide new evidence whether the less-is-more strategy is justified.

Aspirin Use in Women: Current Perspectives and Future Directions.

This review examines the recent literature on the use of low-dose aspirin (LDA) for primary and secondary prevention of cardiovascular disease in women, use of LDA for pre-eclampsia prevention in pregnancy, and the underutilization of aspirin therapy in women as compared to men. While men and women should not differ with respect to aspirin use for secondary prevention, its role in primary prevention remains unclear for both sexes, with particular uncertainty in women. Reflective of this are conflicting recommendations in current guidelines for primary prevention and thus investigations of primary prevention aspirin use are ongoing and will play an important role in elucidating its efficacy. While there is significant heterogeneity in studies to date of LDA for pre-eclampsia prevention, based on recent meta-analyses suggesting promising results, guidelines now recommend initiation in high risk women after the 12th week of gestation. Finally, studies consistently reveal that aspirin therapy is underutilized in women as compared to men, suggesting a need to better educate physicians and the general public about its use in women. Further research is needed to better elucidate the role of aspirin in women for primary prevention of cardiovascular disease and for pre-eclampsia in high risk pregnant women. In addition, further investigation into the factors that lead to the current underutilization of aspirin in women are required in order to ensure that patients of both sexes are optimally treated, with the goal of improving cardiovascular outcomes in all patients.

Aspirin for Primary and Secondary Prevention of Cardiovascular Disease.

The first reported use of salicylate-rich plants as an analgesic and anti-inflammatory agent comes from the Ebers Papyrus, an Egyptian medical text from ca. 1,543 bc.1 It wasn't until the mid-1800s that silicon was isolated as the active component from willow tree bark extract, and then purified to acetylsalicylic acid. Bayer patented the compound in 1900, after the German chemist Felix Hoffmann's successful use of it to treat his father's severe arthritis. Finally, in 1950, the physician Lawrence Craven recognized that aspirin reduced the risk of heart attacks in men.2

Use of Health Care System-Supplied Aspirin by Veterans With Postoperative Heart Attack or Unstable Angina

Evidence-based guidelines for the use of aspirin in secondary prevention of cardiovascular disease events are well established. Despite this, the prevalence of aspirin use for secondary prevention is suboptimal. The study aimed to determine the prevalence of aspirin use for secondary prevention of cardiovascular disease events when it is dispensed as a prescription, as is performed in the Veterans Affairs (VA) managed care system. VA patients who had undergone major surgery and experienced a postoperative myocardial infarction (MI) or unstable angina between the years 2005 and 2009 were identified from administrative databases. VA pharmacy records were used to determine whether a prescription for aspirin was filled after the postoperative MI or unstable angina. Multivariable logistic regression models estimated odd ratios of filling aspirin prescriptions for the predictors of interest. Of the 321,131 men and women veterans who underwent major surgery, 7,700 experienced a postoperative MI or unstable angina. Among those 7,700, 47% filled an aspirin prescription. Only 59% of veterans with no co-pay filled an aspirin prescription. Aspirin fills were more common in younger veterans, Blacks, Hispanics, males, hypertensive veterans, mentally ill patients, those with no co-pay and those prescribed antiplatelets/anticoagulants in addition to aspirin postoperatively. These findings suggest that the impact of dispensing aspirin as a prescription may not be significant in increasing the appropriate use of aspirin for secondary prevention.

The Number Needed to Treat: 25 Years of Trials and Tribulations in Clinical Research.

The number needed to treat (NNT) is a simple measure of a treatment’s impact, increasingly reported in randomized trials and observational studies, but often incorrectly calculated in studies involving varying follow-up times. We discuss the NNT in these contexts and illustrate the concept using several published studies. While the computation of the NNT is founded on the cumulative incidence of the outcome, several published studies use simple proportions that do not account for varying follow-up times, or use incidence rates per person-time. We show how these approaches can lead to erroneous values of the NNT and misleading interpretations. For example, a trial of 3,845 very elderly hypertensives randomized to a diuretic or placebo reported a NNT of 94 treated for 2 years to prevent one stroke, though the correct approach results in a NNT of 63. Also, meta-analyses involving trials of differing lengths often report a single NNT, such as the meta-analysis of 22 trials of the anticholinergic tiotropium in chronic obstructive pulmonary disease that reported a NNT of 16 patients “over one year,” even if the trials varied in duration from 3 to 48 months, with the actual NNTs varying widely from 15 to 250. Finally, we describe the value of the NNT in assessing benefit–risk, such as low-dose aspirin use in secondary prevention of mortality assessed against the risk of gastrointestinal bleeding. As the “number needed to treat” becomes increasingly used in the comparative effectiveness and safety of therapies, its accurate estimation and interpretation become crucial to avoid distorting clinical, economic, and public health decisions.

Use of Low-Dose Aspirin as Secondary Prevention of Atherosclerotic Cardiovascular Disease in US Adults (from the National Health Interview Survey, 2012)

Current guidelines recommend that adults with atherosclerotic cardiovascular disease take low-dose aspirin or other antiplatelet medications as secondary prevention of recurrent cardiovascular events. Yet, no national level assessment of low-dose aspirin use for secondary prevention of cardiovascular disease has been reported in a community-based population. Using data from the 2012 National Health Interview Survey, we assessed low-dose aspirin use in those with atherosclerotic cardiovascular disease. We estimated the prevalence ratios of low-dose aspirin use, adjusting for sociodemographic status, health insurance, and cardiovascular risk factors. In those with atherosclerotic cardiovascular disease (n = 3,068), 76% had been instructed to take aspirin and 88% of those were following this advice. Of those not advised, 11% took aspirin on their own. Overall, 70% were taking aspirin (including those who followed their health care provider's advice and those who were not advised but took aspirin on their own). Logistic regression models showed that women, non-Hispanic blacks and Hispanics, those aged 40 to 64 years, with a high school education or with some college, or with fewer cardiovascular disease risk factors were less likely to take aspirin than men, non-Hispanic whites, those aged ≥65 years, with a college education or higher, or with all 4 selected cardiovascular disease risk factors, respectively. Additional analyses conducted in those with coronary heart disease only (n = 2,007) showed similar patterns. In conclusion, use of low-dose aspirin for secondary prevention was 70%, with high reported adherence to health care providers' advice to take low-dose aspirin (88%) and significant variability within subgroups.

A systematic review of aspirin in primary prevention: is it time for a new approach?

Background and ObjectivesWhile evidence in support of aspirin use in secondary prevention is well documented, the role of aspirin in primary prevention remains unclear. We conducted a systematic literature review to evaluate aspirin use in cardiovascular disease (CVD) and cancer primary prevention, and consider whether aspirin’s role is set to become more clearly defined based on past and prospective studies.Data SourcesUtilizing PubMed, the reviewers identified appropriate Medical Subject Headings (MeSH) terms to establish CVD-based studies, cancer-based studies, and studies on adherence.Study Eligibility CriteriaDate restrictions of May 31, 2008 to May 31, 2013 were applied to capture the most robust meta-analyses and randomized controlled trials. Websites of relevant EU and US scientific societies were used to identify the key guidelines for aspirin use in primary prevention of CVD, and ClinicalTrials.gov was used to establish future or ongoing trials.ResultsEvidence in support of aspirin prophylaxis is conflicting, though some meta-analyses have underlined potential benefit in reducing cardiovascular events. Despite this apparent benefit, bleeding risk with aspirin is consistently higher versus control, and remains a concern. A reduction of cancer incidence and mortality after a least 3 and 5 years treatment, respectively, is also apparent with aspirin.ConclusionAvailable data on aspirin in primary prevention suggest a modest benefit for patients at high risk of CVD, and a promising benefit for those at risk of cancer. Future studies should help to elucidate whether the benefit of aspirin outweighs risk in appropriate patient groups.

Utilização de ácido acetilsalicílico (AAS) na prevenção de doenças cardiovasculares: um estudo de base populacional

The objective of this study was to estimate the prevalence of aspirin use in primary and secondary prevention of cardiovascular disease. A population-based cross-sectional study was conducted in Pelotas, Rio Grande do Sul State, Brazil, from January to May 2010. The study had two outcomes: 1) aspirin use in primary prevention (individuals > 40 years of age with at least two risk factors: hypertension, diabetes mellitus, and/or hyperlipidemia) and 2) aspirin use in secondary prevention (history of stroke and/or angina/myocardial infarction). The outcomes were analyzed based on demographic, socioeconomic, and lifestyle variables. Prevalence of aspirin use was 24.8% for primary prevention and 34.3% for secondary prevention. In primary prevention, aspirin use was more common in non-whites and older individuals and among those with worse self-rated health. For secondary prevention, aspirin use was more frequent among older and higher-income individuals and former smokers. Prevalence of aspirin use was well below recommended levels for prevention of cardiovascular diseases.

Underuse of Aspirin for Primary and Secondary Prevention of Cardiovascular Disease Events in Women

Evidence-based guidelines for use of aspirin to decrease cardiovascular disease (CVD) events in women are well established. Despite this, aspirin is underused in women. We examined self-reported aspirin use in women for primary and secondary prevention of CVD events, correlates of use, and change in use over time from 2004 to 2009. Data from volunteer respondents participating in a web-based CVD risk assessment tool at 127 US healthcare centers were analyzed. Survey questions included information on CVD risk factors, the presence or absence of any form of CVD, diabetes mellitus, and medication usage, including daily aspirin. Logistic regression analyses identified factors associated with aspirin intake. Of the 217,987 women respondents, 29,701 women were recommended to take aspirin based on the guidelines. We found, however, that only 41% of women who meet criteria for primary prevention and 48% of women who meet criteria for secondary prevention report that they take aspirin on a daily basis. The main factors that favored aspirin use were a family history of CVD or high cholesterol. Although aspirin use for secondary prevention did not change between the years 2004 and 2009, there was a significant increase in aspirin use for primary prevention. These findings confirm that the majority of women for whom aspirin is recommended for primary and secondary prevention of CVD were not following national guidelines. Educational programs for clinicians and women aimed at promoting appropriate use of aspirin is one measure that should improve CVD outcomes in women.

P2-312 Aspirin use in cardiovascular disease prevention: a population-based study

ObjectiveTo estimate the prevalence of aspirin use in primary and secondary prevention of cardiovascular disease.MethodsPopulation-based cross-sectional study was carried out in Pelotas, Southern Brazil, between Jan and May/2010, with people...

Prescription of aspirin for adults with diabetes

BACKGROUND:To evaluate the prescription of aspirin for primary and secondary prevention of cardiovascular disorders in diabetic patients, in the light of American Diabetes Association guidelines.MATERIALS AND METHODS:In this retrospective analysis, presence of any cardiovascular disease or cardiovascular disease risk factor as defined in American Diabetes Association guidelines and the use of aspirin and other medication data were extracted from the case files of 100 patients with type 2 diabetes mellitus visiting two teaching hospitals.RESULTS:Of 100 patients studied, 58% were men and 42% women and all were ≥ 40 years of age. 45% had at least one cardiovascular disease and all (100%) were on aspirin for secondary prevention; 45% had one or more risk factors, of which 11% (05/45) had aspirin prescribed for primary prevention; remaining 10% had neither risk factors nor cardiovascular disease (but age ≥ 40 years) and no aspirin documentation. Reasons for not using aspirin/antiplatelet drug were not recorded.CONCLUSIONS:American Diabetes Association recommendations for aspirin use for secondary prevention of cardiovascular diseases were strictly adhered to, in contrast to that for primary prevention. Under-prescription of aspirin could be attributed to the physicians' concern about the burden of poly-pharmacy and toxic effects of aspirin on long-term use. Extensive efforts are necessary to enhance aspirin use in this regard.

Gender Differences in Aspirin use Among Adults With Coronary Heart Disease in the United States

BackgroundAspirin reduces mortality for men and women with coronary heart disease (CHD). Previous research suggests women with acute coronary syndromes receive less aggressive care, including less frequent early administration of aspirin. The presence of gender differences in aspirin use for secondary prevention is less clear.ObjectiveTo determine if a gender difference exists in the use of aspirin for secondary prevention among individuals with CHD.DesignWe analyzed data from the nationally representative 2000–2002 Medical Expenditure Panel Surveys to determine the prevalence of regular aspirin use among men and women with CHD.ParticipantsParticipants, 1,869, 40 years and older who reported CHD or prior myocardial infarction.ResultsWomen were less likely than men to use aspirin regularly (62.4% vs 75.6%, p < .001) even after adjusting for demographic, socioeconomic and clinical characteristics (adjusted OR = 0.62, 95% CI, 0.48–0.79). This difference narrowed but remained significant when the analysis was limited to those without self-reported contraindications to aspirin (79.8% vs 86.4%, P = .002, adjusted OR = 0.68, 95% CI, 0.48–0.97). Women were more likely than men to report contraindications (20.5% vs 12.5%, P < .001). Differences in aspirin use were greater between women and men with private health insurance (61.8% vs 79.0%, P < .001, adjusted OR = 0.48, 95% CI, 0.35–0.67) than among those with public coverage (62.5% vs 70.7%, P = .04, adjusted OR = 0.74, 95% CI, 0.50–1.11) (P < .001 for gender–insurance interaction).ConclusionWe found a gender difference in aspirin use among patients with CHD not fully explained by differences in patient characteristics or reported contraindications. These findings suggest a need for improved secondary prevention of cardiovascular events for women with CHD.

Aspirin use for secondary prevention is low in women

Aspirin use for secondary prevention is low in women

Aspirin use for primary and secondary prophylaxis of cardiovascular disease

Background: The benefits of aspirin use for the secondary and primary prevention of cardiovascular disease (CVD) have been demonstrated in several clinical trials. Objective: The purpose of this study was to estimate the prevalence of aspirin use for primary and secondary prophylaxis of CVD and to identify predictors associated with its use. Methods: A retrospective, cross-sectional study was conducted using data from the Behavioral Risk Factor Surveillance System from 1997 to 1999 to identify individuals using aspirin for the primary and secondary prevention of CVD. Logistic regression procedures were used to determine the contribution of various predictors of aspirin use. Results: The prevalence of aspirin use for both primary and secondary prevention of CVD increased from 1997 to 1999. In 1999, the rate of aspirin use for secondary prevention (72.4%) was >3 times the rate of use for primary prevention (19.8%). Use of aspirin for primary and secondary prevention was greater among whites, men, and those aged 65 to 74 years. Better compliance with other preventive care recommendations such as influenza vaccinations, cholesterol screening, and pneumonia vaccination; eating less fat and exercising more; and existing risk factors for CVD such as hypertension and high blood cholesterol were positively associated with aspirin use for primary and secondary prevention of CVD. Conclusions: Aspirin use rates for secondary prevention were higher than the rates for primary prevention because of the strong evidence linking aspirin use with the prevention of recurrence of a cardiovascular event. However, there is still an opportunity to promote the use of an inexpensive and effective drug such as aspirin for the primary prevention of CVD among patients who have risk factors for CVD and no contraindications to aspirin use. Increased adherence to cost-effective preventive measures such as aspirin therapy can contribute significantly to reducing the societal burden of CVD.