CNN
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For adults who have survived a heart attack or stroke, are taking aspirin regularly It may reduce the risk of another cardiovascular event. But new research suggests that less than half of these cardiovascular disease patients worldwide use aspirin to prevent new disease.
Only about 40% of people with a history of cardiovascular disease investigated in the new study reported taking aspirin to prevent another heart attack, stroke, or cardiovascular event.
The proportion of patients using aspirin to reduce the risk of secondary events varies by country, with 16.6% in low-income countries such as Afghanistan, Benin and Ethiopia, and 16.6% in high-income countries such as the Czech Republic and the United Kingdom. 65% and a wide range.According to a study released Tuesday, the United States Medical journal JAMA.
“We expected higher rates of aspirin use for secondary prevention. I think one of the efforts is to improve the use of these evidence-based drugs,” said study author Dr. Sangune Yu. Cardiovascular Disease Research Fellow, Department of Cardiovascular Medicine, Washington University School of Medicine, St. Louis.
Secondary prevention refers to using aspirin to reduce the risk of secondary or additional heart attacks or strokes. This is different from primary prevention, which uses aspirin to reduce the risk of an initial heart attack or stroke.
Unlike primary prevention, where the risk-benefit ratio of aspirin is less clear, the available studies on secondary prevention show that the benefits of taking aspirin far outweigh the risks for people who have had a heart attack or stroke. is shown.
The World Health Organization has Target at least 50% of the target population Taking any medications or counseling to prevent heart attack or stroke.
Cardiovascular disease is the leading cause of death worldwide, claiming approximately 18 million lives each year. According to WHO. It is estimated that more than four of his five deaths from cardiovascular disease are due to heart attack or stroke.because Aspirin helps thin the bloodhelps reduce the risk of clogged arteries that can cause heart attacks and strokes.
“Our research highlights that despite efforts to improve cardiovascular health around the world, aspirin is underutilized as a secondary prevention agent. That’s it,” Yoo said. “Given that aspirin continues to be the leading cause of death, it is critical that health systems and countries strategize how to improve the use of aspirin and other cardiovascular drugs.”
For the new study, Yoo and colleagues at the University of Washington, the University of Michigan, and other institutions around the world analyzed data from 51 countries surveyed between 2013 and 2020. Seven of the studies were conducted in low-income countries and 23 were surveyed. There are 14 low-middle-income countries, 7 upper-middle-income countries, and 7 high-income countries.
The survey included responses from more than 124,500 adults aged 40 to 69 who reported a history of cardiovascular disease and aspirin use. More than 10,500 of them reported suffering from cardiovascular disease.
When researchers looked at aspirin use in people with a history of cardiovascular disease, they found that 16.6% in low-income countries were taking aspirin to prevent another disease. In low- and middle-income countries it was 24.5%. In upper middle-income countries it was 51.1%. 65% in high-income countries.
“To our knowledge, this study provides the most extensive and up-to-date estimates of global aspirin use for secondary prevention of cardiovascular disease,” the researchers said. Abbreviations for vascular disease were used.
“Our findings reveal striking inequalities around the world, as evidenced by four times more aspirin use for secondary prevention of CVD in high-income countries than in low-income countries.” write the researchers. “None of the 30 low- or lower-middle-income countries in our sample met the WHO target of at least 50% of subjects with a history of CVD taking aspirin.” Only about half of the upper-middle-income and high-income countries included in our analysis achieved this target.”
Professor Yu said the study did not analyze why this difference occurred with lower aspirin use, which could be related to access to health care providers and other factors that discourage aspirin. More research is needed to determine whether
The researchers found that among people with a history of cardiovascular disease, those who were older, male, more educated, and lived in urban areas were more likely to use aspirin.
The researchers say their findings suggest that aspirin is underutilized worldwide as an inexpensive means of secondary prevention of cardiovascular events. Low-dose aspirin is available over-the-counter in the United States. Costs as little as $5-$10.
“We live in a time when there are incredibly well-established treatments that are effective in reducing the risk of cardiovascular events, and despite a large body of evidence supporting their use. , we use many life-saving drugs suboptimally, and this is just one example,” said Jeffrey Berger, M.D., director of the Langonhart Center for Cardiovascular Disease Prevention at New York University. , he was not involved in this new study.
He noted that, just as people do not take aspirin for secondary prevention, many people with cardiovascular disease who could benefit from regular exercise and a healthy diet also do not adhere to those habits. , added.
“Aspirin has been around for over a century. It has been shown to be effective in reducing the risk of cardiovascular events for nearly 40 years, or more than 40 years. I think we’re forgetting that,” said Berger, who is also an associate professor at New York University’s Grossman School of Medicine.
“Unfortunately, misunderstandings can occur between patients and providers,” he says. “I think there’s a lot of uncertainty about who should take aspirin to prevent a first heart attack or stroke.”
of Recommended by the United States Task Force on Preventive Services For adults aged 60 and older and people aged 40 to 59 starting low-dose aspirin for primary prevention of cardiovascular disease People with a 10-year risk of cardiovascular disease or greater are left to the discretion of physicians and patients. But that’s very different than someone with a history of cardiovascular disease taking aspirin to prevent a second heart attack or stroke.
“Aspirin is a double-edged sword,” Dr. Erin Mikos, associate chair of the Department of Preventive Cardiology at Johns Hopkins School of Medicine in Baltimore, wrote in an email.
“It can reduce the risk of thrombosis, but it comes at the cost of increased risk of bleeding, which limits the therapeutic reach. It’s a delicate balance between the risk of thrombosis and the risk of bleeding.” , said Michos, who was not involved in the new study.
“People who have already had a cardiovascular event such as heart attack, coronary revascularization, or stroke are at higher risk of recurrence and therefore have a higher vascular risk and therefore a greater net benefit from aspirin.” she said.
For people without cardiovascular disease, the absolute risk of vascular events such as heart attack and stroke is lower, but the risk of bleeding is still the same.
Therefore, for most healthy adults who take aspirin for primary prevention, “aspirin may do more harm than good,” Michos said. “However, this article shows that aspirin is still underutilized for secondary prevention around the world, especially in low-income countries.”
