Aspirin Use to Prevent Cardiovascular Disease and Colorectal Cancer (original) (raw)
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Role of Aspirin in Cancer Prevention
Current Oncology Reports, 2013
| Clinical guidelines for prophylactic aspirin use currently only consider the cardiovascular benefits of aspirin, weighed against the potential harm from aspirin-induced bleeding. Daily aspirin use has been convincingly shown to reduce the risk of colorectal cancer and recurrence of adenomatous polyps, but in average-risk populations, these benefits alone do not outweigh harms from aspirin-induced bleeding. Recently published secondary analyses of cardiovascular trials provide the first randomized evidence that daily aspirin use may also reduce the incidence of all cancers combined, even at low doses (75-100 mg daily). This Review considers the general mechanism of action that defines aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) as a class, the specific advantages of aspirin over other NSAIDs for prophylactic use, the current evidence concerning the main health outcomes affected by aspirin use, and the hypothesis that inhibition of platelet activation may mediate both the cardioprotective and cancer-preventive effects of lowdose aspirin. It also considers how even a 10% reduction in overall cancer incidence beginning during the first 10 years of treatment could tip the balance of benefits and risks favourably in average-risk populations.
[Aspirin in primary and secondary prevention of colorectal carcinomas]
Medizinische Monatsschrift Fur Pharmazeuten, 2013
Web Table 1: Baseline characteristics of the primary and secondary prevention trials Number of participants Male Age, years Blood pressure (SBP/DBP), mmHg Total cholesterol, mmol/L Current smokers Body mass index, kg/m 2 Diabetes mellitus Hypertension Any vascular disease Primary prevention trials British Doctors Study 5139 100% 61 (7) 136 (17) / 83 (10)-* The relevance of male gender can be assessed only in the two trials that included both men and women, so the confidence intervals for its relevance are wide, particularly for stroke. GI = Gastrointestinal. Total cholesterol was not available in the British Doctors Study. Excluding the 2% of participants with known history of vascular disease. Rate ratios for cholesterol are per 1mmol/L and for mean blood pressure per 20mmHg.
The Risks and Benefits of Prophylactic Aspirin in vascular disease and cancer
Substantial evidence from randomized trials confirms benefit from aspirin in the secondary reduction of vascular disease but there is debate about its use in primary prevention. More recently, evidence from long-term follow up and other studies indicates a reduction in cancer by aspirin. The undesirable effects of aspirin include gastrointestinal bleeding and, rarely, cerebral bleeding. However, deaths from gastrointestinal bleeding attributable to aspirin appear not to be increased, suggesting that the bleeds provoked by aspirin are not the most serious. There is also suggestive, but limited, evidence that cerebral bleeds may occur only in the presence of uncontrolled hypertension. It is important that in considering the risk-benefit balance of aspirin prophylaxis from a public health point of view, reductions in vascular disease events and in cancer are considered together. Furthermore, low-dose aspirin is prophylaxis and not treatment, and so advice about aspirin should be given to subjects within the context of a healthy lifestyle to enable them to make informed decisions about the protection of their own health.
Aspirin Use and Misuse for the Primary Prevention of Cardiovascular Diseases
American Journal of Preventive Medicine, 2021
Introduction: Daily aspirin use for primary cardiovascular disease prevention is common among adults. Numerous clinical trials observe reduced cardiovascular disease with regular low-dose aspirin. The U.S. Preventive Services Task Force in 2016 published guidelines for aspirin use, but controversy exists about the side effects, and overuse or underuse may be common despite the guidelines. Using the Task Force recommendations, this paper describes the prevalence of appropriate aspirin use and physician advice in a population sample. Methods: A random sample of men and women (aged 50−69 years) living in the Upper Midwest in 2017−2018 were surveyed, collecting demographic data, health history, and aspirin use. Appropriate primary prevention with aspirin was defined as having ≥10% cardiovascular disease risk (hypertension, hyperlipidemia, diabetes, smoking) with daily or every other day aspirin use. Those with prevalent cardiovascular disease were labeled as secondary prevention. Results: A total of 1,352 adults were surveyed (697 women, 655 men). The criteria for secondary prevention were fulfilled in 188 participants, and these were eliminated from the analysis. In the remaining group, aspirin was indicated in 32.9% (383 of 1,164). Among those, 46.0% (176 of 383) were appropriate users, and 54.0% (207 of 383) were nonusers despite indications. Overuse, where aspirin is not indicated, was common at 26.9% (210 of 781). Discussion with a physician, although reported in 29% of subjects, was associated with some improvement in the appropriate use but also with overuse and underuse. Conclusions: Aspirin use for primary cardiovascular disease prevention is common. However, many adults are medicating without indication (overuse) or are not using aspirin despite guidelines (underuse).
2020
Aspirin had been introduced as a nonsteroidal anti-inflammatory molecule. As further research on aspirin started, other therapeutic effects have been revealed. Now, this molecule has become the polychrest in medical science. Aspirin has served as a drug of choice for the primary prevention of cardiovascular disease (CVD) for the last few decades. However, recent trials have raised questions on the use of aspirin for CVD prevention due to some life-threatening adverse drug events. In spite of that, outcomes of trials will surely assist to frame a guideline for anoxic administration regimen of aspirin in order to prevent CVD.
Evaluation of the Benefits and Harms of Aspirin for Primary Prevention of Cardiovascular Events
The information in this report is intended to help health care decisionmakers-patients and clinicians, health system leaders, and policymakers, among others-make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients. This report may be used, in whole or in part, as the basis for the development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied. This report may periodically be assessed for the urgency to update. If an assessment is done, the resulting surveillance report describing the methodology and findings will be found on the Effective Health Care Program Web site at www.effectivehealthcare.ahrq.gov. Search on the title of the report. This document is in the public domain and may be used and reprinted without permission except those copyrighted materials that are clearly noted in the document. Further reproduction of those copyrighted materials is prohibited without the specific permission of copyright holders.
An Update on Aspirin in the Primary Prevention of Cardiovascular Disease
Archives of Internal Medicine, 2003
Background: In 1988, the aspirin component of the Physicians' Health Study, a randomized, double-blind, placebo-controlled trial of 22 071 apparently healthy men was terminated early, due principally to a statistically extreme (PϽ.00001) 44% reduction in the risk of a first myocardial infarction (MI). The Cardio-Renal Drugs Advisory Committee recommended that the US Food and Drug Administration approve professional labeling of aspirin to prevent first MI. The agency did not act on this recommendation because the only other trial, the British Doctors' Trial of 5139 men, showed no significant benefits. Since that time, 3 additional randomized trials (which included men and women) of aspirin in the primary prevention of MI have been published. Methods: A computerized search of the English literature from 1988 to the present revealed 5 published trials: the Physicians' Health Study (22 071 participants), the British Doctors' Trial (5139), the Thrombosis Prevention Trial (5085), the Hypertension Optimal Treatment Study (18 790), and the Primary Prevention Project (4495).