An Update on Aspirin in the Primary Prevention of Cardiovascular Disease

Eidelman, Rachel S.; Hebert, Patricia R.; Weisman, Steven M.; Hennekens, Charles H.

doi:10.1001/archinte.163.17.2006

Cited by 221 publications

(133 citation statements)

References 14 publications

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“…A meta-analysis of primary cardiovascular event prevention trials in the general population (of whom 80% were men) demonstrated that low-dose aspirin decreases the first MI rate by 32% (relative risk [RR] 0.68, 95% CI 0.59-0.79) but has no effect on the risk of first stroke or cardiovascular death prevention (31). However, the recent Womens' Health Study (WHS) demonstrated that low-dose aspirin reduces the risk of first stroke by 17% (RR 0.83, 95% CI 0.69-0.99) (P ϭ 0.04) but has no effect on the risk of first MI (in individuals Ͻ65 years) or cardiovascular death prevention (32).…”

Section: Discussionmentioning

confidence: 99%

Aspirin for primary thrombosis prevention in the antiphospholipid syndrome: A randomized, double‐blind, placebo‐controlled trial in asymptomatic antiphospholipid antibody–positive individuals

Erkan¹,

Harrison²,

Levy³

et al. 2007

Arthritis & Rheumatism

367

206

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Objective. To determine the efficacy of a daily dose of 81 mg aspirin in primary thrombosis prevention in asymptomatic, persistently antiphospholipid antibody (aPL)-positive individuals (those with positive aPL but no vascular and/or pregnancy events).Methods. The Antiphospholipid Antibody Acetylsalicylic Acid (APLASA) study was a multicenter, randomized, double-blind, placebo-controlled clinical trial in which asymptomatic, persistently aPL-positive individuals were randomized to receive a daily dose of 81 mg of aspirin or placebo. In a separate observational and parallel study, asymptomatic, persistently aPL-positive individuals who were taking aspirin or declined randomization were followed up prospectively.Results. In the APLASA study, 98 individuals were randomized to receive aspirin or placebo (mean ؎ SD followup period 2.30 ؎ 0.95 years), of whom 48 received aspirin and 50 received placebo. In the observational study, 74 nonrandomized individuals were followed up prospectively (mean ؎ SD followup period 2.46 ؎ 0.76 years); 61 received aspirin and 13 did not. In the APLASA study, the acute thrombosis incidence rates were 2.75 per 100 patient-years for aspirin-treated subjects and 0 per 100 patient-years for the placebo-treated subjects (hazard ratio 1.04, 95% confidence interval 0.69-1.56) (P ‫؍‬ 0.83). Similarly, in the observational study, the acute thrombosis incidence rates were 2.70 per 100 patient-years for aspirin-treated subjects and 0 per 100 patient-years for those not treated with aspirin.

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Section: Discussionmentioning

confidence: 99%

Aspirin for primary thrombosis prevention in the antiphospholipid syndrome: A randomized, double‐blind, placebo‐controlled trial in asymptomatic antiphospholipid antibody–positive individuals

Erkan¹,

Harrison²,

Levy³

et al. 2007

Arthritis & Rheumatism

367

206

View full text Add to dashboard Cite

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“…Primary prevention of cardiovascular events through aspirin use is well studied in the general population. In a meta-analysis of 55,580 randomised participants (11,466 women), aspirin treatment was associated with a statistically significant 32% reduction in the risk of a first myocardial infarction and a 15% reduction in all important vascular events, but did not have any significant effects on non-fatal stroke or vascular death [80]. A position statement by the ADA recommended aspirin therapy for primary prevention in diabetic individuals with the following risk factors: a family history of CHD, smoking, hypertension, obesity, microalbuminuria and dyslipidaemia [81].…”

Section: Atherosclerosis Is Earlier and More Severe In Type 1 Diabetesmentioning

confidence: 99%

Atherosclerosis in childhood and adolescent type 1 diabetes: early disease, early treatment?

2005

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Autopsy studies have shown that atherosclerosis begins in adolescence in otherwise healthy individuals, and imaging techniques have shown that atherosclerosis develops earlier and is more prevalent in children with diabetes than in age-matched healthy controls. Cardiovascular disease has now overtaken diabetic nephropathy as the leading cause of premature mortality in young adults with diabetes, and the emphasis on disease prevention has accordingly shifted to a younger age group. The majority of children and adolescents with diabetes have suboptimal blood glucose control, and this contributes to accelerated arterial disease in this age group. Other conventional risk factors for coronary heart disease also need to be considered and treated aggressively. Effective early prevention of cardiovascular disease will involve lifestyle modification and full implementation of existing treatment guidelines, and largescale prospective studies will be needed to establish the risks and benefits of early pharmacological intervention in children and adolescents.

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“…11 More recent analysis of the published literature suggested that the indications for aspirin use should be expanded to primary prevention in populations at high risk, such as those with diabetes, peripheral vascular disease, carotid stenosis, endstage renal disease, 12,13 or polycytemia vera. 14 Of paramount importance are the results of the ISIS-2 trial, which showed that aspirin reduces the mortality from acute MI to an extent that is similar to that of the thrombolytic agent streptokinase.…”

Section: Aspirinmentioning

confidence: 99%

Aspirin and Clopidogrel

Cattaneo

2004

ATVB

371

133

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Abstract-Aspirin and the thienopyridines ticlopidine and clopidogrel are antiplatelet agents that display good antithrombotic activity. In the past few years, the concept of aspirin resistance has been largely emphasized in the medical literature, although its definition is still uncertain. I suggest that "aspirin-resistant" should be considered as a description for those individuals in whom aspirin fails to inhibit thromboxane A 2 production, irrespective of the results of unspecific tests of platelet function, such as the bleeding time, platelet aggregation, or the PFA-100 system. Less well known than aspirin resistance, but certainly better characterized, is the issue of "clopidogrel resistance," which is probably mostly caused by inefficient metabolism of the prodrug clopidogrel to its active metabolite. At present, aspirin and clopidogrel resistance should not be looked for in the clinical setting, because there is no definite demonstration of an association with clinical events conditioning cost-effective changes in patient management. Key Words: aspirin resistance Ⅲ clopidogrel resistance Ⅲ antiplatelet agents Ⅲ cardiovascular diseases Ⅲ cerebrovascular diseases A spirin and the thienopyridines ticlopidine and clopidogrel are inhibitors of platelet aggregation that display good antithrombotic activity. They are used in the prophylaxis of patients undergoing vascular grafting or percutaneous angioplasty, in the medical management of acute coronary syndromes, and in long-term prevention of cardiovascular and cerebrovascular events.Both aspirin and the thienopyridines selectively inhibit a single pathway of platelet activation: aspirin affects the arachidonate-thromboxane A 2 (TxA 2 ) pathway by irreversibly inhibiting cyclo-oxygenase-1 (COX-1) (Figure 1). 1 The thienopyridines affect the adenosine diphosphate (ADP) pathway, by irreversibly blocking the ADP receptor P2Y 12 ( Figure 1). 2 Despite their selective mechanism of action, which does not counteract the many alternative pathways for platelet activation, aspirin and thienopyridines display a good antithrombotic activity. This is explained by the fact that both the arachidonate-TxA 2 pathway and the ADP pathway contribute to the amplification of platelet activation and are essential for the full aggregation and secretion response of platelets to agonists. 2

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An Update on Aspirin in the Primary Prevention of Cardiovascular Disease

Cited by 221 publications

References 14 publications

Aspirin for primary thrombosis prevention in the antiphospholipid syndrome: A randomized, double‐blind, placebo‐controlled trial in asymptomatic antiphospholipid antibody–positive individuals

Aspirin for primary thrombosis prevention in the antiphospholipid syndrome: A randomized, double‐blind, placebo‐controlled trial in asymptomatic antiphospholipid antibody–positive individuals

Atherosclerosis in childhood and adolescent type 1 diabetes: early disease, early treatment?

Aspirin and Clopidogrel

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