For people who already have cardiovascular disease, doctors may recommend that patients take small doses of aspirin for a long time to prevent recurrence of the disease, also known as “secondary prevention”. Studies have shown that secondary prevention can effectively reduce the risk of serious cardiovascular events by 25%, with a 1/3 reduction in non-fatal myocardial infarction, a 1/4 reduction in non-fatal stroke, and a 1/6 reduction in all vascular events.
In the treatment of acute myocardial infarction and acute ischemic stroke, treatment with aspirin for one month resulted in a reduction of 40 and 10 major vascular events per 1000 people, respectively. Therefore, there is no controversy about the efficacy of aspirin in acute ischemic disease and secondary prevention.
However, it is controversial whether low-dose aspirin should be taken for primary prevention in the general population without the occurrence of cardiovascular disease. Recently published data suggest that the benefit of aspirin for prevention of cardiovascular disease in low-risk populations is modest, as the beneficial effects of aspirin are offset by the risk of bleeding due to the risk of bleeding that aspirin can cause.
Currently, cardiovascular and cerebrovascular events are the leading cause of death worldwide, and the incidence of cardiovascular and cerebrovascular disease in China is also growing rapidly. Statistics show that every 15 seconds a Chinese person is killed by cardiovascular and cerebrovascular disease, and every 22 seconds a Chinese person loses his or her ability to work as a result. While cardiovascular diseases are certainly scary, many of them can be prevented as long as we actively pay attention to our own risk factors and carry out scientific prevention. Studies show that by improving high-risk factors, the global incidence of stroke can be reduced by 85% and the incidence of ischemic heart disease by 75%, which shows that primary prevention is a key measure to reduce the burden of cardiovascular and cerebrovascular events, and the concept of prevention must be deeply rooted in people’s hearts.
In cardiovascular and cerebrovascular events, platelet activation is the ultimate common link, so that “no thrombosis, no event”. Among the antiplatelet drugs, aspirin is not only the basic drug for secondary prevention and acute treatment of cardiovascular events, but also the only antiplatelet drug recommended by the guidelines for primary prevention. The results of previous studies have also demonstrated the preventive effect of aspirin in certain populations.
Clarify three concepts
To figure out which groups of people need to take aspirin, we need to clarify the following three concepts.
1, the concept of “healthy people”. The so-called “healthy people without cardiovascular disease” actually includes two types of people, one is a healthy population without risk factors for cardiovascular disease, and the other is a high-risk group of people who already have risk factors for cardiovascular disease, but have not yet developed, including hypertension, diabetes, dyslipidemia, obesity, smoking and other people, that is, the surface The other group is the high-risk group who already have risk factors for cardiovascular disease but have not yet developed the disease, including hypertension, diabetes, dyslipidemia, obesity, smoking, etc., that is, people who look healthy on the surface but are actually not healthy.
In other words, among the healthy people who do not have cardiovascular diseases, all of them should pay attention to lifestyle intervention, and some of the middle and high-risk people need to use drugs for primary prevention.
All medications have pros and cons, and whether they should be taken or not needs to be weighed, and only when the pros outweigh the cons should they be taken. Recently, the U.S. Preventive Services Expert Panel pointed out that aspirin primary prevention is meaningful only when the benefits of preventing cardiovascular disease significantly outweigh the risk of bleeding, and national guidelines for aspirin primary prevention include people at high risk for cardiovascular and cerebrovascular disease as targets for preventive treatment. Therefore, strict screening of people at high risk of cardiovascular and cerebrovascular diseases and adequate assessment of benefit/risk ratio are the keys to the efficacy of aspirin primary prevention.
2. The concept of “risk stratification”. “Generally speaking, for the first group of healthy people mentioned above, routine aspirin use is not recommended. However, the second group of apparently “healthy” people, those who are already at risk for cardiovascular disease, should take aspirin.”
The latest guidelines recommend that the decision to apply aspirin should be based on different age groups and different 10-year cardiovascular disease risk levels, and that aspirin primary prevention is only relevant if the number of cardiovascular events prevented significantly exceeds the risk of bleeding, and in general, patients with intermediate or high risk of cardiovascular events (i.e., 10-year cardiovascular event risk ≥10%-12%) may be considered for aspirin , 75-100 mg/day.
A simple clinical method to determine a patient’s 10-year risk of cardiovascular events ≥10% is: male, >45 years of age with two or more risk factors; female, >55 years of age with two or more risk factors. Risk factors include: hypertension, diabetes, dyslipidemia, obesity, smoking and family history of coronary heart disease (in the first-degree relatives, male relatives less than 55 years old, female relatives less than 65 years old history of coronary heart disease), etc.
3, the concept of “special populations”. According to statistics, the risk of dying from cardiovascular disease is 2-4 times higher in diabetic patients than in the normal population, and the major cardiovascular events in diabetic patients are equivalent to those in patients with coronary heart disease within 10 years, so diabetes is called “coronary heart disease and other risks”. At the same time, diabetes is also a major risk factor for coronary heart disease, so it is now recommended that aspirin should be considered when diabetes is combined with a high-risk factor.
Hypertension is one of the most important risk factors for coronary heart disease, and its risk of developing coronary heart disease is more than four times that of patients without hypertension. When hypertension is combined with one other risk factor, aspirin should also be considered after blood pressure control.
In 2005, China cardiovascular disease report shows that there are 160 million hypertensive patients, more than 23 million diabetic patients, 60 million obese people and 350 million smokers in China, these people are a huge reserve army of cardiovascular disease patients, these people should be more alert to the occurrence of cardiovascular disease and do timely prevention work.
75-100 mg/day is the best dose
There are several aspirin primary prevention studies underway worldwide, and these results will further elucidate the role of aspirin in primary prevention of cardiovascular disease in different populations and are worthy of our anticipation. As more clinical data are published and national guidelines for primary prevention continue to be revised, it is believed that the indications will become clearer. Of course, the dose of aspirin is also an issue of great concern.
Studies have shown that the average optimal dose of aspirin for long-term application to inhibit platelet function is 100 mg/day; 75-100 mg/day is generally considered to be the optimal dose for long-term use in primary prevention.”
In conclusion, combined with the current findings, universal aspirin use for cardiovascular disease prevention in the entire healthy population should not be advocated, and aspirin should be given for primary prevention in populations where the clinical benefit outweighs the risk. Guidelines in all countries recommend that people with intermediate or high risk of cardiovascular disease should consider long-term use of low-dose aspirin.