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Would You Recommend Aspirin to This Patient for Primary Prevention of Atherosclerotic Cardiovascular Disease? : Grand
Risa B Burns1, Michael Pignone2, Erin D Michos3
1Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts (R.B.B., Z.K.).
Annals of Internal Medicine
|October 11, 2021
Summary
Aspirin use for primary prevention of atherosclerotic cardiovascular disease (ASCVD) is complex. Guidelines suggest considering low-dose aspirin for adults aged 40-70 with high ASCVD risk, balancing benefits against bleeding risks.
Area of Science:
- Cardiology
- Preventive Medicine
- Clinical Decision-Making
Background:
- Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of death.
- The role of aspirin in primary prevention of ASCVD is not fully established.
- Balancing aspirin's benefits and harms is challenging for clinicians and patients.
Purpose of the Study:
- To discuss the application of current guidelines on aspirin for primary ASCVD prevention.
- To address how to assess ASCVD risk, including the role of coronary artery calcium scores.
- To guide decisions on initiating or stopping aspirin therapy based on risk-benefit analysis.
Main Methods:
- Expert discussion on applying 2019 American College of Cardiology/American Heart Association guidelines.
- Review of ASCVD risk assessment strategies.
- Consideration of coronary artery calcium scoring in risk stratification.
- Analysis of benefit-harm thresholds for aspirin recommendation.
- Patient counseling strategies for aspirin decision-making.
Main Results:
- U.S. Preventive Services Task Force (2016) recommends aspirin for ASCVD risk >10%.
- 2019 ACC/AHA guidelines suggest considering low-dose aspirin for select adults (40-70 years) at higher ASCVD risk without increased bleeding risk.
- Coronary artery calcium score can aid in ASCVD risk assessment and decision-making.
Conclusions:
- Individualized ASCVD risk assessment is crucial for primary prevention decisions.
- Low-dose aspirin may be considered for primary ASCVD prevention in specific patient populations.
- Shared decision-making is essential to balance potential benefits and harms of aspirin therapy.
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