Aspirin for prophylactic use in the primary prevention of cardiovascular disease and cancer: a systematic review and overview of reviews

Sutcliffe, Paul; Connock, Martin; Gurung, Tara; Freeman, Karoline; Johnson, Samantha; Kandala, Ngianga‐Bakwin; Grove, Amy; Gurung, Binu; Morrow, Susan L.; Clarke, Aileen

doi:10.3310/hta17430

Cited by 78 publications

(58 citation statements)

References 151 publications

(582 reference statements)

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“…11 However, both the USPSTF and a UK panel have emphasized the need for additional research into the effect of long-term aspirin use on not only the incidence of CRC, but overall cancer, according to a range of doses and by subgroups, including age, sex, baseline cancer risk, or comorbid conditions. 12,13 It is also unclear what the additional impact of aspirin use on cancer would be in the setting of screening, including lower endoscopy, 11 which is associated with a significantly lower risk of CRC. 14 …”

Section: Introductionmentioning

confidence: 99%

Population-wide Impact of Long-term Use of Aspirin and the Risk for Cancer

et al. 2016

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Importance The U.S. Preventive Services Task Force recently recommended the use of aspirin to prevent colorectal cancer and cardiovascular disease among many U.S adults. However, the association of aspirin on risk of other cancer types, and aspirin’s potential population-wide impact on cancer, particularly within the context of screening, remain uncertain. Objective To examine potential benefits of aspirin use for overall and subtype-specific cancer prevention, at a range of doses and duration of use, and estimate the absolute benefit of aspirin in the context of screening. Design Two large prospective cohort studies: the Nurses’ Health Study (NHS, 1980–2010) and Health Professionals Follow-up Study (HPFS, 1986–2012). Setting Health professionals in the United States Participants 88,084 women and 47,881 men participating in the NHS and HPFS who reported aspirin use biennially. Main Outcome Measures Relative risks (RRs) for incident cancers and population attributable risk (PAR). Results During up to 32 years of follow-up, we documented 20,414 cancers among women and 7,571 among men. Compared with nonregular use, regular aspirin use was associated with lower risk of overall cancer (RR 0.97; 95% CI 0.94, 0.99), which was primarily due to a lower incidence of gastrointestinal cancers (RR 0.85; 95% CI 0.80, 0.91), especially colorectal cancers (RR 0.81; 95% CI 0.75, 0.88). The benefit of aspirin on gastrointestinal cancers appeared evident with use of at least 0.5 to 1.5 standard aspirin tablets per week; the minimum duration of regular use associated with lower risk was 6 years. Among individuals aged over 50, regular aspirin use could prevent 33 colorectal cancers (PAR 17.0%) among those who have not undergone a lower endoscopy and 18 colorectal cancers per 100,000 person-years (PAR 8.5%) among those who have. Regular aspirin use was not associated with risk of breast, advanced prostate, or lung cancer. Conclusions and Relevance Long-term aspirin use was associated with modest but significantly reduced risk of overall cancer, especially gastrointestinal tumors. Regular aspirin use may prevent a substantial proportion of colorectal cancers and complement the benefits of screening.

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Section: Introductionmentioning

confidence: 99%

Population-wide Impact of Long-term Use of Aspirin and the Risk for Cancer

et al. 2016

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“…1 Accordingly, anti-platelet medications including aspirin and ADP/P2Y 12 receptor blockers such as clopidogrel and GIIb/IIIa inhibitors that reduce platelet reactivity are commonly used in the primary and secondary prevention of several cardiovascular conditions, including stroke and MI. 2,3 Investigating the biological mechanisms that govern platelet number (PLT) and size (MPV) can provide insights into platelet development and clearance and has the potential to enhance our understanding of human diseases.…”

Section: Introductionmentioning

confidence: 99%

Platelet-Related Variants Identified by Exomechip Meta-analysis in 157,293 Individuals

Eicher

Chami

Kacprowski

et al. 2016

The American Journal of Human Genetics

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Platelet production, maintenance, and clearance are tightly controlled processes indicative of platelets' important roles in hemostasis and thrombosis. Platelets are common targets for primary and secondary prevention of several conditions. They are monitored clinically by complete blood counts, specifically with measurements of platelet count (PLT) and mean platelet volume (MPV). Identifying genetic effects on PLT and MPV can provide mechanistic insights into platelet biology and their role in disease. Therefore, we formed the Blood Cell Consortium (BCX) to perform a large-scale meta-analysis of Exomechip association results for PLT and MPV in 157,293 and 57,617 individuals, respectively. Using the low-frequency/rare coding variant-enriched Exomechip genotyping array, we sought to identify genetic variants associated with PLT and MPV. In addition to confirming 47 known PLT and 20 known MPV associations, we identified 32 PLT and 18 MPV associations not previously observed in the literature across the allele frequency spectrum, including rare large effect (FCER1A), low-frequency (IQGAP2, MAP1A, LY75), and common (ZMIZ2, SMG6, PEAR1, ARFGAP3/PACSIN2) variants. Several variants associated with PLT/MPV (PEAR1, MRVI1, PTGES3) were also associated with platelet reactivity. In concurrent BCX analyses, there was overlap of platelet-associated variants with red (MAP1A, TMPRSS6, ZMIZ2) and white (PEAR1, ZMIZ2, LY75) blood cell traits, suggesting common regulatory pathways with shared genetic architecture among these hematopoietic lineages. Our large-scale Exomechip analyses identified previously undocumented associations with platelet traits and further indicate that several complex quantitative hematological, lipid, and cardiovascular traits share genetic factors.

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“…Эффективное снижение АД приводит к снижению риска ВЧГ в 2 раза. Метаанализы, изучавшие соотношение дозы АСК и риск ВЧГ, не выявили какой-либо закономерности [12].…”

Section: больной с артериальной гипертензиейunclassified

Primary Prevention of Cardiovascular Disease and Antiplatelet Therapy. Clinical Lecture

Минушкина

2017

Medicinskij sovet

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ПРАКТИКА ОЦЕНКА РИСКА СЕРДЕЧНОСОСУДИСТЫХ ОСЛОЖНЕНИЙДля оценки риска сердечно-сосудистых осложнений в нашей стране обычно используется европейская шкала оценки риска SCORE. Существуют и другие шкалы риска. Это американская шкала ASCVD, британская QRISK, шкалы Рейнолдс, PROCAM и некоторые другие. Эти шкалы отли-чаются между собой по количеству учитываемых в них факторов риска, категориям больных, для которых шкала предназначена, оцениваемым неблагоприятным исходам и т. д. Сравнение диагностической ценности различных шкал обычно проводится по площади под кривой «чув-ствительность -специфичность».Шкала SCORE оценивает риски сердечно-сосудистой смертности за 10 лет. Эта шкала предназначена для оцен-ки риска у лиц 40-65 лет. Среди факторов риска она учитывает возраст, пол, уровень систолического артери-ального давления, уровень общего холестерина и холе-стерина ЛВП, а также факт курения. Критерием очень высокого риска считается 10%-ный риск смерти за 10 лет. Шкала SCORE имеет 2 основные модификации для стран с высоким и низким сердечно-сосудистым риском. Площадь под кривой «чувствительность -специфич-ность» составляет для мужчин 0,76, для женщин -0,79. Исследования по валидации этой шкалы показывают ее диагностическую ценность 0,66-0,74. К преимуществам шкалы SCORE относят ее простоту, учет наиболее распро- ASA is the only antiplatelet agent the administration of which is debated for primary prevention. Administration of ASA in primary prevention usually results in a reduced risk of cardiovascular complications, but the positive effect is largely offset by an increased risk of bleeding, particularly gastrointestinal. Therefore, the challenge is in the selection of patients for whom the benefit from antithrombotic therapy could outweigh the risks associated with bleeding. Risk scores are commonly used to assess the risk of complications.

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Aspirin for prophylactic use in the primary prevention of cardiovascular disease and cancer: a systematic review and overview of reviews

Abstract: The National Institute for Health Research Health Technology Assessment programme.

Cited by 78 publications

References 151 publications

Population-wide Impact of Long-term Use of Aspirin and the Risk for Cancer

Population-wide Impact of Long-term Use of Aspirin and the Risk for Cancer

Platelet-Related Variants Identified by Exomechip Meta-analysis in 157,293 Individuals

Primary Prevention of Cardiovascular Disease and Antiplatelet Therapy. Clinical Lecture

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