https://doi.org/10.4081/itjm.2024.1770
Acetylsalicylic acid in primary prevention: a review
Published: 29 August 2024
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
The role of acetylsalicylic acid in secondary cardiovascular prevention is established. However, its role in primary prevention is much more controversial. In this review, we analyzed meta-analyses and trials regarding aspirin in primary prevention and, consequently, hemorrhagic risk related to anti-platelet therapy. Several factors have been considered (e.g., sex, comorbidities, bleeding risk factors, concomitant drugs, weight, age), aspirin’s pharmacokinetics included. In the end, we tried to individualize anti-aggregation therapy based on the risk/benefit ratio of every single subject. In conclusion, high-cardiovascular-risk subjects must be treated with acetylsalicylic acid in primary prevention according to their bleeding risk. For better cardiovascular stratification, other tools to detect risk modifier factors should be used (e.g., instrumental evaluations).
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Citations
Visseren FLJ, Mach F, Smulders YM, et al. 2021 ESC guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J 2021;42:3227-37.
DOI: https://doi.org/10.1093/eurheartj/ehab484
Marx N, Federici M, Schütt K, et al. 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes Eur Heart J 2023;44:4043-140.
BittnerV. The new 2019 AHA/ACC guideline on the primary prevention of cardiovascular disease. Circulation 2020;142:2402-4.
DOI: https://doi.org/10.1161/CIRCULATIONAHA.119.040625
Hlavorsen S, Andreotti F, Berg JM, et al. Aspirin therapy in primary cardiovascular disease prevention. A position paper of the European Society of Cardiology working group on thrombosis. J Am Coll Cardiol 2014;64:319-27.
DOI: https://doi.org/10.1016/j.jacc.2014.03.049
Hansson L, Zanchetti A, Carruthers SG, et al. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. HOT study group. Lancet 1998;351:1755-62.
DOI: https://doi.org/10.1016/S0140-6736(98)04311-6
ASCEND Study Collaborative Group, Bowman L, Mafham M, et al. Effects of aspirin for primary prevention in persons with diabetes mellitus. N Engl J Med 2018;379:1529-39.
DOI: https://doi.org/10.1056/NEJMoa1804988
Gaziano JM, Brotons C, Coppolecchia R, et al. Use of aspirin to reduce risk of initial vascular events in patients at moderate risk of cardiovascular disease (ARRIVE): a randomised, doubleblind, placebo-controlled trial. Lancet 2018;392:1036-46.
DOI: https://doi.org/10.1016/S0140-6736(18)31924-X
McNeil JJ, Wolfe R, Woods RL, et al. Effect of aspirin on cardiovascular events and bleeding in the healthy elderly. N Engl J Med 2018;379:1509-18.
DOI: https://doi.org/10.1056/NEJMoa1805819
Hennekens CH, Buring JE. Epidemiology in medicine, little, brown and company. Boston, Lippincot: Wolters Kluver, 1987.
Zheng SL, Roddick AJ. Association of aspirin use for primary prevention with cardiovascular events and bleeding events. JAMA 2019;321:277-87.
DOI: https://doi.org/10.1001/jama.2018.20578
Mahmoud AN, Gad MM, Elgendy AY, et al. Efficacy and safety of aspirin for primary prevention of cardiovascular events: a meta-analysis and trial sequential analysis of randomized controlled trials. Eur Heart J 2019;40:607-17.
DOI: https://doi.org/10.1093/eurheartj/ehy813
Abdelaziz HK, Saad M, Pothineni NVK, et al. Aspirin for primary prevention of cardiovascular events. J Am Coll Cardiol 2019;73:2915-29.
DOI: https://doi.org/10.1016/j.jacc.2019.03.501
Ridker PM, Cook NR, Lee IM, et al. A randomized trial of low-dose aspirin in the primary prevention of cardiovascular disease in women. N Engl J Med 2005;352:1293-304.
DOI: https://doi.org/10.1056/NEJMoa050613
Berger JS, Roncaglioni MC, Avanzini F, et al. Aspirin for the primary prevention of cardiovascular events in women and men: a sex-specific meta-analysis of randomized controlled trials. JAMA 2006;295:306-13.
DOI: https://doi.org/10.1001/jama.295.3.306
Dasa O, Pepine CJ, Pearson TA. Aspirin in primary prevention: what changed? A critical appraisal of current evidence. Am J Cardiol 2021;141:38-48.
DOI: https://doi.org/10.1016/j.amjcard.2020.11.014
Belch J, MacCuish A, Campbell I, et al. The prevention of progression of arterial disease and diabetes (POPADAD) trial: factorial randomised placebo controlled trial of aspirin and antioxidants in patients with diabetes and asymptomatic peripheral arterial disease. BMJ 2008;337:a1840.
DOI: https://doi.org/10.1136/bmj.a1840
Steering Committee of the Physicians’ Health Study Research Group. Final report on the aspirin component of the ongoing Physicians’ Health Study. N Engl J Med 1989;321:129-35.
DOI: https://doi.org/10.1056/NEJM198907203210301
Palmer MK, Toth PP. Trends in lipids, obesity, metabolic syndrome, and diabetes mellitus in the United States: an NHANES analysis (2003‐2004 to 2013‐2014). Obesity 2019;27:309-14.
DOI: https://doi.org/10.1002/oby.22370
Norgard NB. Obesity and altered aspirin pharmacology. Clin Pharmacokinet 2018;57:663-72.
DOI: https://doi.org/10.1007/s40262-017-0611-8
Rothwell PM, Cook NR, Gaziano JM, et al. Effects of aspirin on risks of vascular events and cancer according to bodyweight and dose: analysis of individual patient data from randomised trials. Lancet 2018;392:387-99.
DOI: https://doi.org/10.1016/S0140-6736(18)31133-4
Woods RL, Polekhina G, Wolfe R, et al. No Modulation of the effect of aspirin by body weight in healthy older men and women. Circulation 2020;141:1110-2.
DOI: https://doi.org/10.1161/CIRCULATIONAHA.119.044142
Rocca B, Santilli F, Pitocco D, et al. The recovery of platelet cyclooxygenase activity explains interindividual variability responsiveness to lowdose aspirin in patients with and without diabetes. J Thromb Haemost 2012;10:1220-30.
DOI: https://doi.org/10.1111/j.1538-7836.2012.04723.x
Soodi D, Van Wormer J, Reskalla SH. Aspirina in primary prevention ODF cardiovascular events. Clin Med Res 2020;18:89-94.
DOI: https://doi.org/10.3121/cmr.2020.1548
Lordkipanidzé M, Pharand C, Palisaitis DA, Diodati JG. Aspirin resistance: truth or dare. Pharmacol Ther 2006;112:733-43.
DOI: https://doi.org/10.1016/j.pharmthera.2006.05.011
Li L, Qu C,WU X, et al. Patterns and levels of platelet glycosylation in patients with coronary heart disease and type 2 diabetes mellitus. J Thromb Thrombolysis 2018;45:56-65.
DOI: https://doi.org/10.1007/s11239-017-1573-2
Lordkipanidze M, Shousha S, Diodati G. Platelet response to aspirin: leading the way towards individualized therapy. Curr Topics Pharmacol 2012;16:45-51.
Seidu S, Kunutsor SK, Sesso HJ, et al. Aspirin has potential benefits for primary prevention of cardiovascular outcomes in diabetes: updated literature based and individual participant data meta analyses of randomized controlled trials. Cardiovasc Diabetol 2019;18:70.
DOI: https://doi.org/10.1186/s12933-019-0875-4
Cebrián-Cuenca A, Manel Mata-Cases M, Franch-Nadal J, et al. Half of patients with type 2 diabetes mellitus are at very high cardiovascular risk according the ESC/EASD: data from a large Mediterranean population. Eur J Prev Cardiol 2021;28:e32-4.
DOI: https://doi.org/10.1093/eurjpc/zwaa073
Reilly IA, FitzGerald GA. Inhibition of thromboxane formation in vivo and ex vivo: implications for therapy with platelet inhibitory drugs. Blood 1987;69:180-6.
DOI: https://doi.org/10.1182/blood.V69.1.180.bloodjournal691180
Wallace J, Vong L. NSAID-induced gastrointestinal damage and the design of GI-sparing NSAIDs. Curr Opin Investig Drugs 2008;9:1151-6.
Antithrombotic Trialists’ Collaboration, Baigent C, Blackwell L, et al. Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet 2009;373:1849-60 .
DOI: https://doi.org/10.1016/S0140-6736(09)60503-1
Patrono C, Ciabattoni G, Patrignani P, et al. Clinical pharmacology of platelet cyclooxygenase inhibition. Circulation 1985;72:1177-84.
DOI: https://doi.org/10.1161/01.CIR.72.6.1177
Antiplatelet Trialists’s Collaboration. Collaborative meta-analysis of randomized trials of antiplatelet therapyfor prevention of death, myocardial infarction, and stroke in high risk patients. BMJ 2002;324:71-86.
DOI: https://doi.org/10.1136/bmj.324.7329.71
Whitlock EP, Burda BU, Williams SB, et al. Bleeding risks with aspirin use for primary prevention in adults: a systematic review for the U.S. preventive services task force. Ann Intern Med 2016;164:826-35.
DOI: https://doi.org/10.7326/M15-2112
Lanas A, Fuentes J, Benito R, et al. Helicobacter pylori increases the risk of upper gastrointestinal bleeding in patients taking low-dose aspirin. Aliment Pharmacol Ther 2002;16:779-86.
DOI: https://doi.org/10.1046/j.1365-2036.2002.01230.x
Seshasai SRK, Wijesuriya S, Sivakumaran R, et al. Effect of aspirin on vascular and nonvascular outcomes: meta-analysis of randomized controlled trials. Arch Intern Med 2012;172:209-16.
DOI: https://doi.org/10.1001/archinternmed.2011.628
Graham I, Atar D, Borch-Johnsen K, et al. European guidelines on cardiovascular disease prevention in clinical practice: executive summary: fourth joint task force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts). Eur Heart J 2007;28:2375-414.
DOI: https://doi.org/10.1093/eurheartj/ehm316
Hawkey CH, Avery A, Coupland CA, et al. Helicobacter pylori eradication for primary prevention of peptic ulcer bleeding in older patients prescribed aspirin in primary care (HEAT): a randomised, double-blind, placebo-controlled trial. Lancet 2022;400:1597-606.
DOI: https://doi.org/10.1016/S0140-6736(22)01843-8
Devereaux PJ, Anderson DR, Gardner MJ, et al. Differences between perspectives of physicians and patients on anticoagulation in patients with atrial fibrillation: observational study commentary: varied preferences reflect the reality of clinical practice. BMJ 2001;323:1218-22.
DOI: https://doi.org/10.1136/bmj.323.7323.1218
Istituto Superiore di sanità. Carta del rischio cardiovascolare. 2023. Available from: https://www.cuore.iss.it/valutazione/carte.
Cosentino F, Grant PJ, Aboyans V, et al. 2019 ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Herat J 2020;41:255-323.
DOI: https://doi.org/10.1093/eurheartj/ehz486
How to Cite
Campanini, M., Rizzi, E., Fleetwood, T., Pinna, G., & Giacomini, G. M. (2024). Acetylsalicylic acid in primary prevention: a review. Italian Journal of Medicine, 18(3). https://doi.org/10.4081/itjm.2024.1770
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