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Risk assessment and aspirin use in Asian and Western populations
1Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, PR China. gaorunlin@263.net
Insights
Aspirin is underutilized for cardiovascular disease (CVD) prevention globally, particularly in Asia. Further research is needed to optimize aspirin use and risk assessment in diverse populations.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Cardiovascular disease (CVD) poses a significant global health challenge.
- Aspirin is a widely used medication for CVD prevention.
- Disparities exist in aspirin utilization and risk assessment between Asian and Western countries.
Purpose of the Study:
- To review aspirin utilization for cardiovascular disease (CVD) prophylaxis.
- To compare cardiovascular risk estimation strategies in Asian and Western populations.
- To examine the clinical evidence supporting aspirin use in different regions.
Main Methods:
- Conducted a literature search using PubMed.
- Utilized keywords such as "aspirin", "Asia", and "Western".
- Synthesized findings on aspirin use, risk scores, and clinical evidence.
Main Results:
- Aspirin is underutilized in high-risk patients in both Asian and Western countries.
- Risk estimation scores require validation in Asian countries like Japan, India, and South Asia.
- Underutilization in Asia may stem from overestimated bleeding risks, potentially due to Helicobacter pylori infection and genetic factors.
Conclusions:
- Aspirin should be prescribed for CVD prevention when the risk-benefit ratio is favorable.
- Ongoing trials will provide crucial data on aspirin's benefits in Asian patients.
- Improved data may enhance aspirin utilization and risk assessment globally.
Objective:
The aim of this review was to examine aspirin utilization, cardiovascular risk estimation, and clinical evidence for aspirin prophylaxis in Asian versus Western countries.
Methods:
A literature search was performed using PubMed and the key terms "aspirin" and "Asia" or "Western".
Results:
Despite the growing burden of cardiovascular disease (CVD), aspirin is underutilized in high-risk patients in both Asian and Western countries. A number of risk estimation scores are available; however, validation is needed in countries such as Japan, India, and in South Asia. Underutilization of aspirin in Asia may be linked to an overestimation of bleeding risks. It is possible that a higher prevalence of Helicobacter pylori infection and genetic differences may make Asians more susceptible to gastrointestinal bleeding. Very low aspirin doses and even the wider use of gastroprotective agents may be the optimal approach to high-risk patients in Asia.
Conclusions:
Based on the current evidence, aspirin should be used for CVD prevention when the risk:benefit ratio is favorable. A number of trials are underway, including the Diabetic Atherosclerosis Prevention by Cilostazol and Japanese Primary Prevention Project, which will provide key data on the benefits of aspirin in Asian patients at risk of CVD, and may improve aspirin utilization and risk estimation.
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