Advertisement
Assessing Aspirin Use for CVD Prevention

Assessing Aspirin Use for CVD Prevention

Aspirin has been shown to help reduce the risk of major cardiovascular events and is recommended by the United States Preventive Services Task Force to prevent heart attacks and ischemic strokes. The drug is used as a primary strategy to help prevent a first occurrence of cardiovascular disease (CVD). It can also be used as secondary prevention for survivors of heart attacks and strokes to prevent additional cardiovascular events. The American Heart Association recommends daily low‐dose aspirin for people at high risk of heart attacks and regular use of low‐dose aspirin for heart attack survivors. “Preventing CVD events is particularly important,” says Arch G. Mainous, PhD. “Understanding physician recommendations for aspirin therapy is critical to the delivery of quality care.” Few studies, however, have evaluated patient use of aspirin and reported physician recommendations of aspirin therapy for CVD prevention.   Suboptimal Use In a study published in the Journal of the American Heart Association, Dr. Mainous and colleagues analyzed data from the National Health and Nutrition Examination Survey, 2011–2012 and examined aspirin use for preventing CVD. The study showed that only about 41% of high-risk individuals reported being told by their physician to take aspirin, and just 79% of these patients actually complied with the recommendation. Among low-risk patients, 26% were told by their physician to take aspirin, with nearly 77% complying. Several factors were identified as significant predictors of patients reporting that their physician recommended aspirin use for primary prevention. These included age, access to a regular source of care, education, and insurance status. Among high‐risk patients, significant predictors were age, race, and insurance status. Age, education, obesity,...
UA/NSTEMI: A Guideline Update

UA/NSTEMI: A Guideline Update

Following the recent FDA approval of new medications to reduce cardiovascular death and heart attack in patients with acute coronary syndromes (ACS) and developments in the literature, the American College of Cardiology (ACC) and American Heart Association (AHA) released a focused update to 2007 guidelines on the management of patients with unstable angina (UA)/NSTEMI. The update, published in Circulation, focuses on how antiplatelets and anticoagulants fit into management algorithms for ACS. Key Updates to UA/NSTEMI Guidelines An important change in the ACC/AHA guideline update is that ticagrelor is now considered a treatment option for UA/NSTEMI patients, joining clopidogrel and prasugrel. “We recommend that when aspirin is given with ticagrelor for maintenance therapy, a low dose of aspirin (81 mg) should be used after the initial loading dose,” says Jeffrey L. Anderson, MD, FACC, FAHA, co-author of the guidelines. “Research shows that a high dose of aspirin appears to reduce the benefits of ticagrelor.” Aspirin remains a first-line therapy for managing patients with UA/NSTEMI. “When these patients arrive at the hospital, they should receive aspirin and an anticoagulant,” says Dr. Anderson. “Clinicians should then decide upon a second antiplatelet agent before angiography to define coronary anatomy. Clopidogrel, ticagrelor, or an intravenous glyco­protein IIb/IIIa agent are acceptable options. At or after coronary stenting, prasugrel becomes an additional option.” For patients receiving medical therapy only, the ACC/AHA guidelines recommend antiplatelet therapy with ticagrelor or clopidogrel, in addition to aspirin. Several changes were made in the guideline update regarding patients with renal insufficiency. “It’s important to assure that these patients are well hydrated if they’re going to the cath lab and that they...

Preoperative Aspirin & Cardiac Surgery Outcomes

Preoperative aspirin therapy appears to be associated with a significantly lower risk of major cardiocerebral complications and renal failure, according to results from a large study of patients undergoing cardiac surgery. The authors also found that preoperative aspirin was linked to shorter ICU stays and lower 30-day mortality when compared with no aspirin therapy. Abstract: Annals of Surgery, February...

Helpful Guidelines for Heart Health in Diabetes

This Physician’s Weekly feature covering guidelines for heart health in diabetes was completed in cooperation with the experts at the American Diabetes Association. Research has shown that patients with diabetes are at two to four times greater risk of suffering cardiovascular disease (CVD) events when compared with patients who do not have diabetes. Several mechanisms have been linked to the increased CVD risk in people with diabetes, including increased intracoronary thrombus formation, elevated platelet reactivity, and worsened endothelial dysfunction. “Aspirin has been shown to be effective in reducing cardiovascular morbidity and mortality in high-risk patients with heart attack or stroke,” explains Craig D. Williams, PharmD. “However, there has been some confusion surrounding the use of aspirin in patients who do not yet have CVD. That confusion is even greater among patients with diabetes.” In 2007, the American Diabetes Association and the American Heart Association (AHA) jointly recommended that aspirin be used as a primary prevention strategy in patients with diabetes who are at increased cardiovascular risk. This patient group includes those who are older than 40 or who have additional risk factors, such as a family history of CVD, hypertension, smoking, dyslipidemia, or albuminuria. “These recommendations were derived from older trials that included fewer patients with diabetes,” says Dr. Williams. “We now have results from two recent randomized controlled trials—the Japanese Primary Prevention of Atherosclerosis with Aspirin for Diabetes and the Prevention of Progression of Arterial Disease and Diabetes trials—in which aspirin use was examined specifically in patients with diabetes. These studies provide important insights on the efficacy of aspirin for primary prevention in diabetes, but they have also...
[ HIDE/SHOW ]