HelixTalk Episode #97 - ASPREE, ARRIVE, ASCEND: Making an Acronym Soup for Aspirin

Date posted: June 18, 2019, 6:00 am

In this episode, we discuss the latest and the greatest updates regarding aspirin use in primary prevention and provide you with a summary of results from recently published primary literature.

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Key Concepts

1. Previous evidence for aspirin use in primary prevention has been unclear but new RCTs in 2018 shed more light on the subject. Based on this new evidence, the cardiovascular benefit does not outweigh the bleeding risk in most patients. 
2. Guidelines recommend AGAINST the routine use of low-dose aspirin in primary prevention for individuals 70+ years old or those with an increased risk of bleeding.
3. The use of aspirin for primary prevention should be reserved for those 40-70 years old with high ASCVD risk (>20% 10-year ASCVD risk) including those with diabetes (>10% 10-year ASCVD risk). 
4. Individualized approach should be taken in deciding whether to use aspirin for primary prevention or reconsidering continued use in patients who have been on aspirin for primary prevention. This should take into account patient’s ASCVD risk as well as bleeding risk.

References

• Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019 Mar 17:CIR0000000000000678.
• Bowman L, Mafham M, Wallendszus K, et al. ASCEND Study Collaborative Group. Effects of aspirin for primary prevention in persons with diabetes mellitus. N Engl J Med. 2018;379(16):1529–39.
• Gaziano MJ, Brotons C, Coppolecchia R, et al. Use of aspirin to reduce risk of initial vascular events in patients at moderate risk of cardiovascular disease (ARRIVE): a randomized, double-blind, placebo-controlled trial. Lancet 2018;392(10152):1036-46.
• McNeil JJ, Nelson MR, Woods RL, et al. Effect of aspirin on all-cause mortality in the healthy elderly. N Engl J Med. 2018; 379:1519-1528.
• Zheng SL, Roddick AJ. Association of Aspirin Use for Primary Prevention With Cardiovascular Events and Bleeding Events: A Systematic Review and Meta-analysis. JAMA. 2019;321(3):277–287. doi:10.1001/jama.2018.20578.