Risk assessment and aspirin use in Asian and Western populations

Abstract

ObjectiveThe aim of this review was to examine aspirin utilization, cardiovascular risk estimation, and clinical evidence for aspirin prophylaxis in Asian versus Western countries.MethodsA literature search was performed using PubMed and the key terms “aspirin” and “Asia” or “Western”.ResultsDespite the growing burden of cardiovascular disease (CVD), aspirin is underutilized in high-risk patients in both Asian and Western countries. A number of risk estimation scores are available; however, validation is needed in countries such as Japan, India, and in South Asia. Underutilization of aspirin in Asia may be linked to an overestimation of bleeding risks. It is possible that a higher prevalence of Helicobacter pylori infection and genetic differences may make Asians more susceptible to gastrointestinal bleeding. Very low aspirin doses and even the wider use of gastroprotective agents may be the optimal approach to high-risk patients in Asia.ConclusionsBased on the current evidence, aspirin should be used for CVD prevention when the risk:benefit ratio is favorable. A number of trials are underway, including the Diabetic Atherosclerosis Prevention by Cilostazol and Japanese Primary Prevention Project, which will provide key data on the benefits of aspirin in Asian patients at risk of CVD, and may improve aspirin utilization and risk estimation.

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“…Most patients were naïve to any treatment before study enrollment (Table 1 ), and analgesic use in China is low overall compared with the United States [ 36 ]. It is therefore possible that patients benefitted from initiation of treatment or from encouragement to use analgesics for pain control.…”

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“…This explains why, for the purposes of this study, we identified a group of people with a SCORE result between 5% and 9%, and considered that they had relative indications for primary cardiovascular preventive therapy. We believe that a SCORE result of 10% or higher better indicates the necessity for cardiovascular pharmacological prevention in older people [23]. …”

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“…Findings from the landmark Japanese Primary prevention of atherosclerosis with Aspirin for Diabetes (JPAD) trial also support the tolerability and safety of low-dose ASA (80 to 100 mg/day) [37]. As hemorrhagic stroke is more common in the Japanese than Western populations [38], it was encouraging that the risk of hemorrhagic stroke was similar between the treatment and control group in the JPAD trial [37]. Moreover, a 10-year follow-up of the patients enrolled in the original JPAD trial found no increased risk of cardiovascular events with low-dose ASA use but slight increased risk ( p = 0.03) for gastrointestinal bleeding [39].…”

“…In the above studies reviewed, there were no reports of any severe adverse events related to ASA use. Findings from the landmark Japanese Primary prevention of atherosclerosis with Aspirin for Diabetes (JPAD) trial also support the tolerability and safety of low-dose ASA (80 to 100 mg/day) [37]. As hemorrhagic stroke is more common in the Japanese than Western populations [38], it was encouraging that the risk of hemorrhagic stroke was similar between the treatment and control group in the JPAD trial [37].…”