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Expert Review of Cardiovascular Therapy Sep 2019: While the clinical merits of aspirin in secondary cardiovascular disease (CVD) prevention remain undisputed, its role in primary prevention is controversial. Recently,... (Review)
Review
: While the clinical merits of aspirin in secondary cardiovascular disease (CVD) prevention remain undisputed, its role in primary prevention is controversial. Recently, three trials of primary prevention reported neutral net benefit results or evidence of harm for aspirin in patients with no overt CVD. : This article aims to inform clinical practitioners by appraising the current body of evidence on the use of aspirin for primary CVD prevention, ranging from general pharmacology to clinical outcomes and future directions. : Based on meta-analyses incorporating latest trials in the field of primary prevention, the modest reduction in ischemic events with aspirin, if any, is offset by a modest increase in nonfatal bleeding. Improved control of CVD risk factors and broader use of statins may have reduced the thrombotic complications of atherosclerosis, thus limiting the opportunity for aspirin to prevent clinical CVD events in the contemporary era. As such, decision-making about aspirin for primary prevention is challenging even when selected patients are considered and involves careful weighing of risks and benefits. Ongoing investigations conducted in patients with cancer could rapidly modify the current perception of the unfavorable benefit-risk ratio of aspirin in patients with no overt CVD.
Topics: Aspirin; Atherosclerosis; Cardiovascular Diseases; Decision Making; Hemorrhage; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Patient Selection; Primary Prevention
PubMed: 31382819
DOI: 10.1080/14779072.2019.1651199 -
Journal of Clinical Lipidology 2021Clinical lipidology belongs par excellence to the preventive mode of medical practice. This Roundtable brings two long-time advocates of cardiometabolic prevention and a...
Clinical lipidology belongs par excellence to the preventive mode of medical practice. This Roundtable brings two long-time advocates of cardiometabolic prevention and a newly minted preventive cardiologist into a discussion that expands their recent JCL editorial on this topic. Atherosclerosis is a single disease process that leads to approximately 25% of deaths in economically advanced nations and a growing fraction of mortality and morbidity in nations with developing and emerging economies. Our discussants suggest that at least 75% of atherosclerotic cardiovascular disease can be prevented. Diet and lifestyle including physical activity are the cornerstones for this effort. Public and private choices about diet-lifestyle are influenced by economics, education (especially in childhood), inequities, technology, misinformation, and trust. Lipid clinics perform well with pharmacologic treatment of lipid disorders and increasingly give attention to hypertension, obesity, and diabetes as needed. Cardiometabolic prevention in the clinic works best through provider teams. Business considerations and exemplary programs are highlighted.
Topics: Cardiovascular Diseases; Diet, Healthy; Exercise; Health Promotion; Humans; Preventive Health Services; Primary Prevention; Risk Factors; Risk Reduction Behavior; Socioeconomic Factors
PubMed: 34815066
DOI: 10.1016/j.jacl.2021.08.004 -
The American Journal of Cardiology Feb 2021Aspirin has been the mainstay of both secondary and primary prevention of cardiovascular disease for half a century. In 2018, 3 trials showed a modest reduction in... (Review)
Review
Aspirin has been the mainstay of both secondary and primary prevention of cardiovascular disease for half a century. In 2018, 3 trials showed a modest reduction in cardiovascular outcomes that appeared counterbalanced by the risk of clinically significant bleeding. The latest ACC/AHA primary prevention guidelines downgraded their recommendation for aspirin use in primary prevention to that of physician preference. Despite the consistent and robust evidence previously supporting the use of aspirin in cardiovascular disease prevention, little discussion has been given to mechanisms or analytic explanations for this revision of recommendations. In this review, we explore 3 possible mechanisms that may have contributed to the alteration of our perception of aspirin's role in primary prevention. These include changes in the population potentially using aspirin in primary prevention, changes in cardiovascular disease and its presentation, and changes in aspirin itself. Here we present a translational look at knowledge gaps that should be addressed to better guide contemporary aspirin use in primary prevention. In conclusion, based on these considerations, the current recommendations might be improved by recalibration of the cardiovascular risk threshold above which aspirin should be recommended for primary prevention, including the incorporation of newer risk assessment modalities such as calcium scoring. A second enhancement would be developing a bleeding risk calculator to support clinicians' assessment of risk vs benefit. The use of enteric-coated aspirin vs noncoated aspirin should also be reassessed.
Topics: Aspirin; Cardiovascular Diseases; Coronary Artery Disease; Evidence-Based Medicine; Heart Disease Risk Factors; Hemorrhage; Humans; Platelet Aggregation Inhibitors; Practice Guidelines as Topic; Primary Prevention; Risk Assessment; Vascular Calcification
PubMed: 33221264
DOI: 10.1016/j.amjcard.2020.11.014 -
JAMA Cardiology Oct 2019
Review
Topics: American Heart Association; Cardiovascular Diseases; Humans; Life Style; Practice Guidelines as Topic; Primary Prevention; United States
PubMed: 31365022
DOI: 10.1001/jamacardio.2019.2604 -
European Heart Journal Nov 2019
Topics: Cardiovascular System; Cohort Studies; France; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Primary Prevention
PubMed: 31495878
DOI: 10.1093/eurheartj/ehz629 -
Current Cardiology Reports Sep 2022In 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... (Review)
Review
PURPOSE OF REVIEW
In 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 FINDINGS
The 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. Until 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.
Topics: Aspirin; Cardiovascular Diseases; Diabetes Mellitus; Humans; Primary Prevention; Risk Factors
PubMed: 35857202
DOI: 10.1007/s11886-022-01740-2 -
Cleveland Clinic Journal of Medicine May 2023
Topics: Humans; Aspirin; Platelet Aggregation Inhibitors; Cardiovascular Diseases; Primary Prevention
PubMed: 37127336
DOI: 10.3949/ccjm.90b.05023 -
JACC. Clinical Electrophysiology Jul 2023
Topics: Aged; Humans; Primary Prevention; Defibrillators
PubMed: 37438047
DOI: 10.1016/j.jacep.2022.12.025 -
Current Atherosclerosis Reports May 2022Heart failure (HF) treatment paradigms increasingly recognize the importance of primary prevention. This review explores factors that enhance HF risk, summarizes... (Review)
Review
PURPOSE OF REVIEW
Heart failure (HF) treatment paradigms increasingly recognize the importance of primary prevention. This review explores factors that enhance HF risk, summarizes evidence supporting the pharmacologic primary prevention of HF, and notes barriers to the implementation of primary prevention of HF with a focus on female and sexual and gender minority patients.
RECENT FINDINGS
HF has pathophysiologic sex-specific distinctions, suggesting that sex-specific preventive strategies may be beneficial. Pharmacologic agents that have shown benefit in reducing the risk of HF address the pathobiology underpinning these sex-specific risk factors. The implementation of pharmacologic therapies for primary prevention of HF needs to consider a risk-based model. Current pharmacotherapies hold mechanistic promise for the primary prevention of HF in females and gender and sexual minorities, although research is needed to understand the specific populations most likely to benefit. There are significant systemic barriers to the equitable provision of HF primary prevention.
Topics: Female; Heart Failure; Humans; Male; Primary Prevention; Risk Factors
PubMed: 35235166
DOI: 10.1007/s11883-022-01009-7 -
Cleveland Clinic Journal of Medicine May 2020Recent trials evaluated the impact of aspirin for primary prevention of cardiovascular events in patients at intermediate risk, patients with diabetes, and the elderly,... (Review)
Review
Recent trials evaluated the impact of aspirin for primary prevention of cardiovascular events in patients at intermediate risk, patients with diabetes, and the elderly, and the results have been incorporated into the most recent professional guidelines. For the most part, the role of aspirin in primary prevention remains limited, albeit not adequately tested in those at higher risk.
Topics: Aspirin; Atherosclerosis; Cardiovascular Diseases; Heart Disease Risk Factors; Humans; Platelet Aggregation Inhibitors; Primary Prevention
PubMed: 32357985
DOI: 10.3949/ccjm.87a.19045