Aspirin for the Primary Prevention of Cardiovascular Disease

James Dalen; Samia Mora; Charles Hennekens

Aspirin for the Primary Prevention of Cardiovascular Disease

Moderator:

James E. Dalen, MD

University of Arizona College of Medicine

Discussants:

Date: February 7, 2012

Roundtable ID: GM80711

Citation: Med Roundtable Gen Med Ed. ; 1(1): 59 - 65.

Summary:
Dr. James Dalen from the University of Arizona, Tucson, AZ moderated the topic "Aspirin for the Primary Prevention of Cardiovascular Disease" with Drs. Charles Hennekens from Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, and Samia Mora from Harvard University, Boston, MA.

The discussion focused primarily on:

1) Randomized trials of aspirin in the primary prevention of cardiovascular disease as well as their meta-analyses;

2) identifying the patients that can benefit from using aspirin as a primary preventive measure;

3) a discussion on the optimal dose of aspirin in primary prevention;

4) the need to assess total cardiovascular risk which includes age and gender in the individual clinical judgment about whether a patient should use aspirin for primary prevention.

(Med Roundtable Gen Med Ed. 2012;1(1):59–65.) ©2012 FoxP2 Media, LLC

Compounds:
No compounds discussed.

Trials:
AAA, ACCEPT-D, ARRIVE, ASCEND, ATT, ESPIRIT, JPAD, JUPITER, PHS, WHS

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“There’s no question that aspirin decreases non-fatal MI in randomized trials of primary prevention and their meta-analyses, probably by about 20% … Because the number of deaths is not decreased, people assume that there’s no merit in preventing nonfatal MI. I don’t agree with that.”
~ James Dalen

“Following an occlusive vascular event in the heart, brain or peripheral vessels, aspirin reduces subsequent vascular events by about a quarter. The magnitude of these benefits of aspirin is far greater than the absolute risks of bleeding.”
~ Charles Hennekens

“It’s a clear-cut strategy to use aspirin for secondary prevention. It’s also clear-cut that the very low-risk patients in primary prevention should not get it for vascular prevention … because of increased risk of bleeding. The trick is knowing whether there are people who are in primary prevention who are at higher risk.”
~ Samia Mora