Aspirin is ideal for people with high coronary calcium and low risk of bleeding-ScienceDaily

Survey results published online today JAMA Cardiology, You can give doctors and patients more specific guidelines for making this important decision.

Due to its anticoagulant properties, aspirin is widely prescribed as a preventative measure for patients who have already experienced cardiovascular events such as heart attack and ischemic stroke. However, the role of aspirin in primary prevention (avoiding the first heart attack or stroke) was unclear, said research leader Amit Kera, MD, professor of internal medicine.

Decades after commonly prescribing aspirin for primary prophylaxis, recent guidelines from the American Heart Association (AHA) and the American College of Cardiology (ACC) show that the risk of cardiac events is high due to the high risk of bleeding. We recommend more selective use for the highest people.

“We generally said yes, sometimes no, about aspirin,” says Kera. “With these new guidelines, we turn it over and say that most people with primary prevention should not use aspirin.”

However, he adds, it is unclear how to choose which patients are most likely to benefit from aspirin therapy, given the risk of bleeding. “We need tools to find sweet spots where aspirin is most beneficial and offsets the associated risks,” he says.

In this study, Krera and his colleagues examined a diagnostic test (coronary calcium (CAC) scan) to see if it could help doctors make this important decision. CAC scans, which are CT scans that record the amount of calcium that covers the arteries of the heart, are commonly performed to detect arteriosclerosis and the risk of a heart attack or stroke.

The researchers collected data from the Dallas Heart Study, an ongoing study that tracks the development of cardiovascular disease in more than 6,000 adults in Dallas County. Initially, participants were invited to three visits to collect various imaging tests, including health and demographic information, laboratory samples, and CAC scans. These volunteers are then followed for an average of 12 years to have a heart attack, death from heart disease, or a non-fatal or fatal stroke (a medical problem collectively referred to as atherosclerotic cardiovascular disease) and / Or tracked the person who had the bleeding event. Caused hospitalization or death.

The researchers used data from 2,191 participants with an average age of 44 years for which CAC scans and follow-up information were available. About 57% were women and 47% were black.

Overall, about half of the participants had a CAC score of 0, suggesting that there was little or no accumulation of calcium in the arteries. A CAC score of about 7% is above 100, suggesting a high accumulation of calcium. The remaining values ​​were in the middle (1-99).

When Khera and his colleagues examined the rates of atherosclerotic cardiovascular disease (ASCVD) and bleeding in a research group, they found that both events gradually increased as the CAC score increased. However, we used statistical modeling to determine the number of ASCVD events that could have been prevented by the use of aspirin, and based on the values ​​collected from recent meta-analyses that provided information to the AHA and ACC guidelines. It turns out that the benefits of aspirin only outweigh the benefits. Risk for patients with a CAC score greater than 100. For this group, the risk of ASCVD was about 15-fold and the risk of bleeding was about 3-fold that of patients with a CAC score of 0.

However, this effect only applies to people who already have a low inherent risk of bleeding, says Kera. That is, as described in the guidelines, if someone had a significant bleeding episode, had a risk factor for bleeding, or had increased bleeding if they were taking medication, regardless of the CAC score, Do not take aspirin for primary prevention.

Together, Kera says that aspirin for primary prevention is only appropriate for patients selected and will strengthen new guidelines that suggest that CAC scans can help doctors and patients make that decision. ..

“Use of aspirin is not a one-size-fits-all treatment,” says Kera, who holds the Dallas Heartball Chair for high blood pressure and heart disease. “CAC scans can be a valuable tool to help more patients adjust their care so that they can avoid their first heart attack or stroke.”

This study was supported by a grant UL1TR001105 from the National Center for Advancing Translational Sciences of the National Institutes of Health. The author’s relevant financial interests are documented in the manuscript.