Low-dose aspirin in the primary prevention of cardiovascular diseases: A retrospective, propensity score matched study

Kim, Seong Pyo; Ryu, Jiwon; Kim, Su Hwan; Yoon, Hyung‐Jin

doi:10.1016/j.atherosclerosis.2023.03.009

Cited by 2 publications

(1 citation statement)

References 33 publications

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“…This was also the case in subgroup analyses from the ARRIVE, ASPREE and ASCEND trials [33][34][35]. However, real-world data from a recent retrospective, propensity score-matched study indicated a blunted aspirin benefit in women with respect to total cardiovascular events, (HR 0.66, 95% CI 0.63-0.69, p not available) [59]. In a subanalysis of the WHS trial [29], the occurrence of major cardiovascular events (death from cardiovascular causes, nonfatal MI, or stroke) was significantly reduced only among women aged 65 years or older (RR 0.74, 95% CI 0.59-0.92, p=0.01), primarily driven by a reduction in MI (RR 0.66, 95% CI 0.44-0.97, p=0.04).…”

Section: Womenmentioning

confidence: 95%

Aspirin in Primary Prevention: Looking for Who Enjoys It!

Della Bona,

Giubilato,

Palmieri

et al. 2024

Preprint

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Based on a wealth of evidence, aspirin is one of the cornerstones of secondary prevention of cardiovascular disease. However, despite several studies showing efficacy also in primary prevention, an unopposed excess risk of bleeding leading to a very thin safety margin is evident in subjects without a clear acute cardiovascular event. Overall, the variability in recommendations from different scientific societies for aspirin use in primary prevention is a classic example of failure of simple risk stratification models based on competing risks (atherothrombosis vs. bleeding), perceived to be opposed but intertwined at the pathophysiological level. Notably, cardiovascular risk is dynamic in nature and cannot be accurately captured by scores, which do not always consider risk enhancers. Furthermore, the widespread use of other potent medications in primary prevention, such as lipid-lowering and anti-hypertensive drugs, might have reduced the benefit of aspirin in recent trials. Some authors, drawing from specific pathophysiological data, have suggested that specific subgroups might benefit more from aspirin. This includes patient with diabetes and those with obesity, as well as considering sex-based differences. Moreover, molecular analysis of platelet reactivity has been proposed. A beneficial effect of aspirin has also been demonstrated for the prevention of cancer, especially colorectal. This review explores evidence and controversies concerning the use of aspirin in primary prevention, considering new perspectives in order to develop a personalized approach.

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Section: Womenmentioning

confidence: 95%

Aspirin in Primary Prevention: Looking for Who Enjoys It!

Della Bona,

Giubilato,

Palmieri

et al. 2024

Preprint

View full text Add to dashboard Cite

show abstract

Aspirin in Primary Prevention: Looking for Those Who Enjoy It

Della Bona,

Giubilato,

Palmieri

et al. 2024

JCM

View full text Add to dashboard Cite

Based on a wealth of evidence, aspirin is one of the cornerstones of secondary prevention of cardiovascular disease. However, despite several studies showing efficacy also in primary prevention, an unopposed excess risk of bleeding leading to a very thin safety margin is evident in subjects without a clear acute cardiovascular event. Overall, the variability in recommendations from different scientific societies for aspirin use in primary prevention is a classic example of failure of simple risk stratification models based on competing risks (atherothrombosis vs. bleeding), perceived to be opposed but intertwined at the pathophysiological level. Notably, cardiovascular risk is dynamic in nature and cannot be accurately captured by scores, which do not always consider risk enhancers. Furthermore, the widespread use of other potent medications in primary prevention, such as lipid-lowering and anti-hypertensive drugs, might be reducing the benefit of aspirin in recent trials. Some authors, drawing from specific pathophysiological data, have suggested that specific subgroups might benefit more from aspirin. This includes patients with diabetes and those with obesity; sex-based differences are considered as well. Moreover, molecular analysis of platelet reactivity has been proposed. A beneficial effect of aspirin has also been demonstrated for the prevention of cancer, especially colorectal. This review explores evidence and controversies concerning the use of aspirin in primary prevention, considering new perspectives in order to provide a comprehensive individualized approach.

show abstract

Low-dose aspirin in the primary prevention of cardiovascular diseases: A retrospective, propensity score matched study

Cited by 2 publications

References 33 publications

Aspirin in Primary Prevention: Looking for Who Enjoys It!

Aspirin in Primary Prevention: Looking for Who Enjoys It!

Aspirin in Primary Prevention: Looking for Those Who Enjoy It

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