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Aspirin and Cardiovascular Disease

 

The old standard line…..”take 2 aspirin and call me in the morning.” Turns out this has some truth about aspirin but not completely so.

Two concepts to understand before we continue. Primary prevention means doing things to prevent the onset of a disease. Secondary prevention means you already have a disease and are trying to do everything to stop it from getting worse.

For many years, we thought aspirin was appropriate for primary and secondary prevention of coronary artery disease (CAD). Recent information has raised some questions about this.

There is absolutely no question that aspirin is helpful in secondary prevention of coronary artery disease. Aspirin is one of the first medications we give when coronary artery disease first strikes and it is an important part of ongoing therapy for CAD.

Primary prevention is another story. Aspirin for years was recommended for primary prevention of CAD. It may have some benefits in that regard. However, a clinical trial study called ARRIVE demonstrated that while aspirin can help in primary prevention of CAD, the benefit may be negated by side effects such as bleeding.

The same result was seen in another clinical trial called ASCEND. This focused on patients with diabetes who are generally more at risk for CAD. There was clearly a benefit of aspirin for primary prevention but it was counterbalanced by bleeding risk.

What do we take from this? The use of aspirin for primary prevention (preventing CAD) is not an automatic move but must be tailored to the individual patient. It is an important discussion to have with your health care provider.

Kenneth Adams MD, Cardiologist, Pentucket Medical