Aspirin in the Modern Era of Cardiovascular Disease Prevention

Abstract

Aspirin’s antithrombotic effects have a long-established place in the prevention of cardiovascular disease (CVD), and its traditional use as a core therapy for secondary prevention of CVD is well recognized. However, with the advent of newer antiplatelet agents and an increasing understanding of aspirin’s bleeding risks, its role across the full spectrum of modern CVD prevention has become less certain. As a consequence, recent trials have begun investigating aspirin-free strategies in secondary prevention. For example, a contemporary metanalysis of trials that assessed P2Y 12 inhibitor monotherapy versus prolonged (≥ 12 months) dual antiplatelet therapy (which includes aspirin) after percutaneous coronary intervention reported a lower risk of major bleeding and no increase in stent thrombosis, all-cause mortality, myocardial infarction (MI), or stroke in the P2Y 12 monotherapy group. In contrast to secondary prevention, aspirin’s role in primary prevention has always been more controversial. While historical trials reported a reduction in MI and stroke, more contemporary trials have suggested diminishing benefit for aspirin in this setting, with no reduction in hard outcomes, and some primary prevention trials have even indicated a potential for harm. In this review, we discuss how changing population demographics, enhanced control of lipids and blood pressure, changes in the definition of outcomes like MI, evolution of aspirin formulations, and updated clinical practice guidelines have all impacted the use of aspirin for primary and secondary CVD prevention.

Aspirin for Primary Prevention of Cardiovascular Diseases: “WALTZ” with the Evidence

“…Numerous randomized controlled trials (RCTs) have been published since the 1980s, with evidence either favoring or questioning the medication’s protective effect in specific populations. [ 6 ] The first 2 major studies addressing the drug’s benefit in individuals without history of CVD—British Male doctors and Physicians Health Study—involved apparently healthy male physicians [ 7 , 8 ]. Concerning total CVD mortality, although the benefit was not proven in both studies, the Physicians showed a significant reduction in the incidence of fatal and nonfatal myocardial infarction (MI) [ 8 ].…”

The Therapeutic Effects of Ligustrazine in Combination with Other Drugs in Cardiovascular Diseases

“…As a metabolic and chronic inflammatory disease, the pathogenesis of atherosclerosis is very complicated, accounting for the challenge of its prevention and treatment. Drugs, such as satins, nitroglycerin, and aspirin, targeting to improve blood lipid profile and arterial functions as well as the inhibition of inflammation, have been developed to treat CVDs [8][9][10]. Due to the limitation of efficiency and the side effects of these therapeutic drugs, the morbidity and mortality due to CVDs remain high in the world.…”

Extraction, Characterization, and Platelet Inhibitory Effects of Two Polysaccharides from the Cs-4 Fungus

“…Numerous studies have shown that downregulating platelet activation might be a promising approach for the prevention and treatment of CVDs [ 4 , 5 ]. However, the antiplatelet drugs (such as aspirin) clinically used may increase the bleeding risk [ 6 ], therefore, the natural antiplatelet ingredients with higher safety attracted increasing attention for improving cardiovascular health.…”