Aspirin is one of the oldest medicine, distinctly known for its pain relief, as well as heart attack prevention. Daily administration of low-dose of aspirin has proven to be beneficial in preventing a heart attack.1
Concept of Primary Prevention of Heart Disease
Primary prevention aims to avert the onset of heart disease by targeting its natural causes and risk factors. Aspirin also may help prevent a first heart attack or stroke in some people. Aspirin helps prevent blood clots from forming and helps prevent heart attack and stroke. Patients who are at risk of heart disease should discuss the role of aspirin with their doctor. 2
Heart Disease as the leading cause of mortality in India – Quick Facts 3
– The Global Burden of Disease study estimated the cardiovascular disease (CVD) death rate of 272 per 100 000 population in India which is higher than the global average of 235 per 100 000 population.
– Premature death in terms of years of life lost because of heart disease in India increased by 59%, from 23.2 million (1990) to 37 million (2010).
– In India, studies have reported increasing heart disease prevalence over the last 60 years, from 1% up to 10% in urban populations and <1% up to 6% in rural populations.
– In India, 52% of heart disease deaths occur before the age of 70 years.
What can be done to prevent cardiovascular disease? 4
Nearly 80% of heart attacks and strokes are preventable. Primary prevention of heart disease and stroke is achievable through simple interventions, such as physical activity, healthy diet, stopping tobacco smoking or chewing and avoiding harmful use of alcohol.
For people aged 40–79 years and who are at high cardiovascular risk, a regimen of aspirin, statin and blood pressure-lowering agents taken on medical advice has been estimated to avert a significant number of premature deaths.
What can individuals do to prevent Heart Disease? 5
1. Do not use tobacco products. If you are already using tobacco, quit immediately.
2. Eat more fruits and vegetables and limit intake of salt, sugar and saturated fats.
3. Achieve and maintain a healthy weight by engaging in regular physical activity (do at least 30 minutes of regular, moderate-intensity activity everyday).
4. Avoid harmful use of alcohol.
5. Take medicines as suggested by your doctor to prevent and control high blood cholesterol, high blood pressure and diabetes.
Aspirin for Primary Prevention of Heart Disease: The Case of Efficacy
– Primary prevention trials have demonstrated benefits with various regimens, including aspirin doses of 75 and 100 mg per day. A dose of 75 mg per day seems as effective as higher doses. 1
– Most of the aspirin benefit in primary prevention was attributable to a 23% proportional reduction in the non-fatal heart attack. 6
– In the pooled clinical trial analysis, aspirin reduced the composite of serious vascular events (a composite of vascular death, heart attack, or stroke) by 12%. 7
Current Guidelines and Recommendations for Aspirin Use
– American Heart Association (AHA) Recommendation – People at high risk of heart attack should take a daily low-dose of aspirin (if told to by their healthcare provider) and that heart attack survivors regularly take low-dose aspirin.8
– American Diabetes Association (ADA) Standards of Medical Care in Diabetes—2017 – The ADA 2017 guidelines recommend aspirin therapy (75–162 mg/day) as a primary prevention strategy in those with type 1 or type 2 diabetes who are at increased cardiovascular risk. This includes most men and women with diabetes aged >50 years who have at least one additional major risk factor and are not at increased risk of bleeding 9
The best way to know if you’re a candidate for aspirin therapy is to ask your healthcare provider. You should not start aspirin on your own.
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References:
1. IttamanS et al. The Role of Aspirin in the Prevention of Cardiovascular Disease. Clin Med Res. 2014 Dec; 12(3-4): 147–154.
2. Saito Yet al. Low-Dose Aspirin for Primary Prevention of Cardiovascular Events in Patients With Type 2 Diabetes Mellitus: 10-Year Follow-Up of a Randomized Controlled Trial. 2017 Feb 14;135(7):659-670.
3. Prabhakaran D, Jeemon P, Roy A. Cardiovascular Diseases in India: Current Epidemiology and Future Directions. 2016 Apr 19;133(16):1605-20.
4. Cardiovascular Diseases fact sheet. WHO South east Asia. September 2011:1-2.
5. How To Prevent and Control Coronary Heart Disease Risk Factors. Available from: https://www.nhlbi.nih.gov/health/health-topics/topics/hd/prevent(as accessed on 05 December 2017)
6. Antithrombotic Trialists’ (ATT) Collaboration. Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet. 2009 May 30; 373(9678): 1849–1860.
7. Leggio M et al. Low-dose aspirin for primary prevention of cardiovascular events in patients with diabetes: Benefit or risk?. Diabetes Metab. 2017:951:1-9.
8. Stewart Primary prevention of cardiovascular disease: A review of contemporary guidance and literature. JRSM Cardiovasc Dis. 2017 Jan-Dec; 6: 1.
9. American Diabetes Association.Cardiovascular Disease and Risk Management. Diabetes Care 2017;40(Suppl. 1):S75–S87.