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[Primary prevention of cardiovascular disease with aspirin: what do the guidelines say?]
Carlos Brotons Cuixart1, Irene Moral Peláez
1Unidad de Investigación, Equipo de Atención Primaria Sardenya, Barcelona, España. cbrotons@eapsardenya.cat
Insights
Guidelines for aspirin use in primary cardiovascular disease prevention show significant variability in recommended risk levels and dosages. Aspirin is generally recommended for diabetics, but with noted discrepancies across guidelines.
Area of Science:
- Cardiology
- Preventive Medicine
- Clinical Guidelines
Background:
- Cardiovascular diseases remain a leading cause of mortality worldwide.
- Aspirin is widely used for secondary prevention of cardiovascular events.
- Its role in primary prevention is subject to ongoing research and guideline development.
Purpose of the Study:
- To systematically review and analyze current guideline recommendations for aspirin use in primary cardiovascular disease prevention.
- To identify consensus and discrepancies in target populations, dosages, and risk stratification criteria.
Main Methods:
- Systematic review of guidelines from major scientific societies and health organizations.
- Data extraction focused on antiplatelet treatment, target populations, dosage, and risk criteria.
- Included publications in English and/or Spanish, disseminated nationally or internationally.
Main Results:
- Nine primary prevention and five diabetes-specific guidelines were reviewed.
- Most guidelines recommend low-dose aspirin (75-325 mg/day).
- Significant variability exists in defining the coronary risk threshold for treatment initiation; diabetes guidelines often lack specific risk stratification.
Conclusions:
- There is substantial heterogeneity among guidelines regarding the risk level for initiating aspirin therapy and recommended dosages.
- While aspirin is generally advised for diabetic patients, inconsistencies persist between and within scientific societies' recommendations.
Objective:
To review the guideline recommendations on aspirin use in primary prevention of cardiovascular diseases.
Design:
Systematic review. The search was made by condition, treatment and type of prevention.
Data Sources:
Science Citation Index, SCOPUS, PubMed, Spanish Ministry of Health, World Health Organisation, web sites of national and international scientific societies.
Data Extraction:
Two investigators independently reviewed all the guidelines. Specific topics assessed: a) use of antiplatelet treatment in primary prevention b) identification of target population c) identification of recommended dosage, d) identification of criteria of aspirin use, e) publications in English and/or Spanish, f) dissemination at national (Spain) or international level.
Results:
Nine guidelines on primary prevention and 5 guidelines on diabetes were reviewed. Most of them recommended low dose aspirin ranging between 75mg and 325mg per day. All the guidelines recommend a specifc level of coronary risk to define the target population to be treated, showing high variability in risk tables used and in the level of risk which should be used to recommend treatment. The diabetes guidelines do not define any level of risk. Three guidelines recommend the use of aspirin when blood pressure is well controlled.
Conclusions:
There is high variability among guidelines in terms of the level of risk from which patients should be treated, and also in dosages. Most of the guidelines recommend the use aspirin in diabetics, although some discrepancies exist among international panels, and even in different documents of the same scientific society.
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