Aspirin and statin therapy for primary prevention of cardiovascular disease in older adults

Abstract

The value of primary preventative therapies for cardiovascular disease (CVD) in older adults (age ≥75 years) is less certain than in younger patients. There is a lack of quality evidence in older adults due to underenrolment in pivotal trials. While aspirin is no longer recommended for routine use in primary prevention of CVD in older adults, statins may be efficacious. However, it is unclear which patient subgroups may benefit most, and guidelines differ between expert panels. Three relevant geriatric conditions (cognitive impairment, functional impairment and polypharmacy) may influence therapeutic decision making; for example, baseline frailty may affect statin efficacy, and some have advocated for deprescription in this scenario. Evidence regarding statins and incident functional decline are mixed, and vigilance for adverse effects is important, especially in the setting of polypharmacy. However, aspirin has not been shown to affect incident cognitive or functional decline, and its lack of efficacy extends to patients with baseline cognitive impairment or frailty. Ultimately, the utility of primary preventative therapies for CVD in older adults depends on potential lifetime benefit. Rather than basing treatment decisions on absolute risk alone, consideration of comorbidities, polypharmacy and life expectancy should play a significant role in decision making. Coronary calcium score and new tools for risk stratification validated in older adults that account for the competing risk of death may aid in evaluating potential benefits. Given the complexity of therapeutic decisions in this context, shared decision making provides an important framework.

Progress on Physical Field‐Regulated Micro/Nanomotors for Cardiovascular and Cerebrovascular Disease Treatment

“…[ 10,11 ] Treatments based on aspirin and statins are common options that can reduce the formation of thrombus and restore the elasticity of endothelial membrane in blood vessels. [ 12,13 ] Alternatively, hypertension, congestive heart failure, and stroke can also be treated with angiotensin‐II receptor blockers and angiotensin‐converting enzyme inhibitors. [ 14 ] Although these medications can improve patient survival and reduce symptoms of the diseases to a certain extent, they may cause organ toxicity and collateral damage to the surrounding healthy tissue.…”

Association Between Aspirin Usage and Age-Related Macular Degeneration: An Updated Systematic Review and Meta-analysis

“…Recently, therapeutic strategies combined with multiple factors, such as daily diet and lifestyle, and preventive pharmacological interventions have been proposed for AMD (Khanani et al, 2022). Aspirin is a widely used antiplatelet drug with proven benefits in lowering cardiovascular risk (Montgomery et al, 2021). A recent European Eye Study reported that regular aspirin usage was associated with AMD, independent of smoking and other risk factors (de Jong et al, 2012).…”

Prescribing aspirin to older people – where is the line between cardiovascular benefit and upper gastrointestinal bleeding risk?

“…2 Aspirin is the most common antiplatelet agent used at 'low dose' for the prevention of cardiovascular events. 3 A low dose with respect to aspirin is commonly defined as doses ranging from 75 to 325 mg daily, and is increasingly produced in enteric-coated formulations in the hope that this might reduce aspirin's gastrointestinal toxicity. 4 Low-dose enteric-coated aspirin has not fulfilled the expectation of reducing gastroduodenal ulceration and bleeding, because the local gastroduodenal irritation and prostaglandin effects are not extinguished.…”

“…Department of Gastroenterology and Hepatology, Fiona Stanley Hospital, 2 Medical School, The University of Western Australia, 3 Faculty of Health Sciences, Curtin University, 4 School of Population and Global Health, The University of Western Australia, and 5 Pharmacy Department, and 6 Cardiology Department, Royal Perth Hospital, Perth, Western Australia, Australia…”

“…Aspirin is the most common antiplatelet agent used at ‘low dose’ for the prevention of cardiovascular events 3 . A low dose with respect to aspirin is commonly defined as doses ranging from 75 to 325 mg daily, and is increasingly produced in enteric‐coated formulations in the hope that this might reduce aspirin's gastrointestinal toxicity 4 .…”