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High Blood Pressure & Cardiovascular Prevention
Published in: High Blood Pressure & Cardiovascular Prevention 3/2017

01-09-2017 | Position paper

Aspirin and the Primary Prevention of Cardiovascular Diseases: An Approach Based on Individualized, Integrated Estimation of Risk

Authors: Massimo Volpe, Allegra Battistoni, Giovanna Gallo, Roberta Coluccia, Raffaele De Caterina

Published in: High Blood Pressure & Cardiovascular Prevention | Issue 3/2017

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Abstract

While the use of aspirin in the secondary prevention of cardiovascular (CVD) is well established, aspirin in primary prevention is not systematically recommended because the absolute CV event reduction is similar to the absolute excess in major bleedings. Recently, emerging evidence suggests the possibility that the assumption of aspirin, may also be effective in the prevention of cancer. By adding to the CV prevention benefits the potential beneficial effect of aspirin in reducing the incidence of mortality and cancer could tip the balance between risks and benefits of aspirin therapy in the primary prevention in favour of the latter and broaden the indication for treatment with in populations at average risk. While prospective and randomized study are currently investigating the effect of aspirin in prevention of both cancer and CVD, clinical efforts at the individual level to promote the use of aspirin in global (or total) primary prevention could be already based on a balanced evaluation of the benefit/risk ratio.
Literature
1.
La rivolta delle masse. Ortega y Gasset Josè. Edizioni SE 2001.
2.
2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J. 2016;37:267–315.
3.
Steg PG, James SK, Atar D, et al. ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2012;33:2569–619.CrossRefPubMed
4.
Mainous AG, Tanner RJ, Shorr RI, Limacher MC. Use of aspirin for primary and secondary cardiovascular disease prevention in the United States, 2011–2012. J Am Heart Assoc. 2014;3:e000989.CrossRefPubMedPubMedCentral
5.
Flossmann E, Rothwell PM, et al. British Doctors Aspirin Trial and the UK-TIA Aspirin Trial. Effect of aspirin on long-term risk of colorectal cancer: consistent evidence from randomized and observational studies. Lancet. 2007;369:1603–13.CrossRefPubMed
6.
Rothwell PM, Wilson M, Elwin CE, Norrving B, Algra A, Warlow CP, et al. Long-term effect of aspirin on colorectal cancer incidence and mortality: 20-year follow-up of five randomized trials. Lancet. 2010;376:1741–50.CrossRefPubMed
7.
Vandvik PO, Lincoff AM, Gore JM, et al. Primary and secondary prevention of cardiovascular disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th edition: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141:e637S–68S.CrossRefPubMedPubMedCentral
8.
Goff DC Jr, Lloyd-Jones DM, Bennett G, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63:2935–59.CrossRefPubMed
9.
2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice. Eur Heart J. 2016;37:2315–81.
10.
Freedman AN, Slattery ML, Ballard-Barbash R. Colorectal cancer risk prediction tool for white men and women without known susceptibility. J Clin Oncol. 2009;27:686–93.CrossRefPubMed
11.
Peto R, Gray R, Collins R, et al. Randomised trial of prophylactic daily aspirin in British male doctors. Br Med. 1988;296:313–6.CrossRef
12.
Ridker PM, Cook NR, Lee IM, et al. A randomized trial of low-dose aspirin in the primary prevention of cardiovascular disease in women. N Engl J Med. 2005;352:1293–304.CrossRefPubMed
13.
Primary Prevention Project Investigators. Low-dose aspirin and vitamin E in people at cardiovascular risk: a randomised trial in general practice. Collaborative Group of the Primary Prevention Project. Lancet. 2001;357:89–95.CrossRef
14.
Steering Committee of the Physicians’ Health Study Research Group. Final report on the aspirin component of the ongoing Physicians’ Health Study. N Engl J Med. 1989;321:129–35.CrossRef
15.
The Medical Research Council’s General Practice Research Framework. Thrombosis prevention trial: randomised trial of low-intensity oral anticoagulation with warfarin and low-dose aspirin in the primary prevention of ischaemic heart disease in men at increased risk. Lancet. 1998;351:233–41.CrossRef
16.
Hansson L, Zanchetti A, Carruthers SG, et al. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. Lancet. 1998;351:1755–62.CrossRefPubMed
17.
Ogawa H, Nakayama M, Morimoto T, et al. Low-dose aspirin for primary prevention of atherosclerotic events in patients with type 2 diabetes: a randomized controlled trial. JAMA. 2008;300:2134–41.CrossRefPubMed
18.
Fowkes FG, Price JF, Stewart MC, et al. Aspirin for prevention of cardiovascular events in a general population screened for a low ankle brachial index: a randomized controlled trial. JAMA. 2010;303:841–8.CrossRefPubMed
19.
20.
Berger JS, Lala A, Krantz MG, Baker GS, Hiatt WR. Aspirin for the prevention of cardiovascular events in patients without clinical cardiovascular disease: A meta-analysis of randomized trials. Am Heart J. 2011;162:115–24.CrossRefPubMed
21.
Antithrombotic Trialists’ (ATT) Collaboration. Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet. 2009;373:1849–60.
22.
Guirguis-Blake JM, Evans CV, Senger CA, O’Connor EA, Whitlock EP. Aspirin for the primary prevention of cardiovascular events: a systematic evidence review for the U.S. Preventive Services Task Force. Ann Intern Med. 2016;164:804–13.CrossRefPubMed
23.
Pignone M, Alberts MJ, Colwell JA, et al. Aspirin for primary prevention of cardiovascular events in people with diabetes: a position statement of the American Diabetes Association, a scientific statement of the American Heart Association and an expert consensus document of the American College of Cardiology Foundation. Circulation. 2010;121:2694–701.CrossRefPubMed
24.
Sarwar N, Gao P, Seshasai SR, et al. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet. 2010;375:2215–22.CrossRefPubMed
25.
Haffner SM, Lehto S, Ronnemaa T, et al. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med. 1998;339:229–34.CrossRefPubMed
26.
ETDRS Investigators. Aspirin effects on mortality and morbidity in patients with diabetes mellitus. Early Treatment Diabetic Retinopathy Study report. JAMA 1992;268:1292–1300.
27.
De Berardis G, Sacco M, Strippoli GF, et al. Aspirin for primary prevention of cardiovascular events in people with diabetes: meta-analysis of randomized controlled trials. BMJ. 2009;339:b4531.CrossRefPubMedPubMedCentral
28.
Zhang C, Sun A, Zhang P, et al. Aspirin for primary prevention of cardiovascular events in patients with diabetes: a meta-analysis. Diabetes Res Clin Pract. 2010;87:211–8.CrossRefPubMed
29.
Calvin AD, Aggarwal NR, Murad MH, et al. Aspirin for the primary prevention of cardiovascular events: a systematic review and meta-analysis comparing patients with and without diabetes. Diabetes Care. 2009;32:2300–6.CrossRefPubMedPubMedCentral
30.
Whitlock EP, Williams SB, Burda BU, Feightner A, Beil T. Aspirin use in adults: cancer, all-cause mortality, and harms. A systematic evidence review for the U.S. Preventive Services Task Force. Evidence Synthesis No. 132. AHRQ Publication No. 13-05193-EF-1. Rockville: Agency for Healthcare Research and Quality; 2015.
31.
Walker J, Robinson J, Stewart J, Jacob S. Does enteric-coated aspirin result in a lower incidence of gastrointestinal complications compared to normal aspirin? Interact Cardiovasc Thorac Surg. 2007;6:519–22.CrossRefPubMed
32.
He J, Whelton PK, Vu B, et al. Aspirin and risk of hemorrhagic stroke: a meta-analysis of randomized controlled trials. JAMA. 1998;280:1930–5.CrossRefPubMed
33.
De Berardis G, Lucisano G, D’Ettorre A, Pellegrini F, Lepore V, Tognoni G, et al. Association of aspirin use with major bleeding in patients with and without diabetes. JAMA. 2012;307:2286–894.CrossRefPubMed
34.
Volpe M, Erhardt LR, Williams B. Managing cardiovascular risk: the need for change. J Hum Hypertens. 2008;22:154–7.CrossRefPubMed
35.
Bendinelli B, Masala G, Saieva C, et al. Fruit, vegetables, and olive oil and risk of coronary heart disease in Italian women: the EPICOR Study. Am J Clin Nutr. 2011;93:275–83.CrossRefPubMed
36.
Warren TY, Barry V, Hooker SP, et al. Sedentary behaviors increase risk of cardiovascular disease mortality in men. Med Sci Sports Exerc. 2010;42:879–85.CrossRefPubMedPubMedCentral
37.
38.
Nelson DE, Jarman DW, Rehm J, et al. Alcohol-attributable cancer deaths and years of potential life lost in the United States. Am J Public Health. 2013;103:641–8.CrossRefPubMedPubMedCentral
39.
Lollgen H, Bockenhoff A, Knapp G. Physical activity and all cause mortality: an updated meta-analysis with different intensity categories. Int J Sports Med. 2009;30:213–24.CrossRefPubMed
40.
41.
Stringhini S, Sabia S, Shipley M, et al. Association of socioeconomic position with health behaviors and mortality. JAMA. 2010;303:1159–66.
42.
Cohen AJ, Ross Anderson H, Ostro B, et al. The global burden of disease due to outdoor air pollution. J Toxicol Environ Health A. 2005;68:1301–7.CrossRefPubMed
43.
Rasmussen-Torvik LJ, Shay CM, Abramson JG, et al. Ideal cardiovascular health is inversely associated with incident cancer: the Atherosclerosis Risk In Communities study. Circulation. 2013;127:1270–5.CrossRefPubMedPubMedCentral
44.
Battistoni A, Mastromarino V, Volpe M. Reducing cardiovascular and cancer risk: how to address global primary prevention in clinical practice. Clin Cardiol. 2015;38:387–94.CrossRefPubMed
45.
Lever AF, Hole DJ, Gillis CR, et al. Do inhibitors of angiotensin-I-converting enzyme protect against risk of cancer? Lancet. 1998;352:179–84.CrossRefPubMed
46.
Volpe M, Azizi M, Danser AH, et al. Twisting arms to angiotensin receptor blockers/antagonists: the turn of cancer. Eur Heart J. 2011;32:19–22.CrossRefPubMed
47.
Wang HM, Liao ZX, Komaki R, et al. Improved survival outcomes with the incidental use of β-blockers among patients with nonsmall-cell lung cancer treated with definitive radiation therapy. Ann Oncol. 2013;24:1312–9.CrossRefPubMedPubMedCentral
48.
49.
Chrispin J, Martin SS, Hasan RK, et al. Landmark lipid-lowering trials in the primary prevention of cardiovascular disease. Clin Cardiol. 2013;36:516–23.CrossRefPubMed
50.
McCowan C, Munro AJ, Donnan PT, et al. Use of aspirin post diagnosis in a cohort of patients with colorectal cancer and its association with all-cause and colorectal cancer–specific mortality. Eur J Cancer. 2013;49:1049–57.CrossRefPubMed
51.
Sandler RS, Halabi S, Baron JA, et al. A randomized trial of aspirin to prevent colorectal adenomas in patients with previous colorectal cancer [published correction appears. N Engl J Med. 2003;348:883–90.CrossRefPubMed
52.
Baron JA, Cole BF, Sandler RS, et al. A randomized trial of aspirin to prevent colorectal adenomas. N Engl J Med. 2003;348:891–9.CrossRefPubMed
53.
Cole BF, Logan RF, Halabi S, et al. Aspirin for the chemoprevention of colorectal adenomas: meta-analysis of the randomized trials. J Natl Cancer Inst. 2009;101:256–66.CrossRefPubMed
54.
Rothwell PM, Fowkes FG, Belch JF, et al. Effect of daily aspirin on long-term risk of death due to cancer: analysis of individual patient data from randomised trials. Lancet. 2011;377:31–41.CrossRefPubMed
55.
Rothwell PM, Price JF, Fowkes FG, et al. Short-term effects of daily aspirin on cancer incidence, mortality, and non-vascular death: analysis of the time course of risks and benefits in 51 randomised controlled trials. Lancet. 2012;379:1602–12.CrossRefPubMed
56.
Rothwell PM, Wilson M, Price JF, et al. Effect of daily aspirin on risk of cancer metastasis: a study of incident cancers during randomised controlled trials. Lancet. 2012;379:1591–601.CrossRefPubMed
57.
Gann PH, Manson JE, Glynn RJ, et al. Low-dose aspirin and incidence of colorectal tumors in a randomized trial. J Natl Cancer Inst. 1993;85:1220–4.CrossRefPubMed
58.
59.
van Kruijsdijk RC, Visseren FL, Ridker PM, Dorresteijn JA, Buring JE, van der Graaf Y, Cook NR. Individualised prediction of alternate-day aspirin treatment effects on the combined risk of cancer, cardiovascular disease and gastrointestinal bleeding in healthy women. Heart. 2015;101:369–76.CrossRefPubMed
60.
Cook NR, Lee IM, Zhang SM, et al. Alternate day, low-dose aspirin and cancer risk: long-term observational follow-up of a randomized trial. Ann Intern Med. 2013;159:77–85.CrossRefPubMedPubMedCentral
61.
Mahmud S, Franco E, Aprikian A. Prostate cancer and use of nonsteroidal anti-inflammatory drugs: systematic review and metaanalysis. Br J Cancer. 2004;90:93–9.CrossRefPubMedPubMedCentral
62.
Luo T, Yan HM, He P, et al. Aspirin use and breast cancer risk: a meta-analysis. Breast Cancer Res Treat. 2012;131:581–7.CrossRefPubMed
63.
Corley DA, Kerlikowske K, Verma R, et al. Protective association of aspirin/NSAIDs and esophageal cancer: a systematic review and meta-analysis. Gastroenterology. 2003;124:47–56.CrossRefPubMed
64.
Wilson JC, Murray LJ, Hughes CM, et al. Non-steroidal antiinflammatory drug and aspirin use and the risk of head and neck cancer. Br J Cancer. 2013;108:1178–81.CrossRefPubMedPubMedCentral
65.
Bosetti C, Rosato V, Gallus S, et al. Aspirin and cancer risk: a quantitative review to 2011. Ann Oncol. 2012;23:1403–15.CrossRefPubMed
66.
Oh SW, Myung SK, Park JY, et al. Aspirin use and risk for lung cancer: a meta-analysis. Ann Oncol. 2011;22:2456–65.CrossRefPubMed
67.
Ni X, Ma J, Zhao Y, et al. Meta-analysis on the association between non-steroidal anti-inflammatory drug use and ovarian cancer. Br J Clin Pharmacol. 2013;75:26–35.CrossRefPubMed
68.
Chubak J, Whitlock EP, Williams SB, Kamineni A, Burda BU, Buist DSM, et al. Aspirin for the prevention of cancer incidence and mortality: systematic evidence reviews for the U.S. Preventive Services Task Force. Ann Intern Med. 2016;164:814–25.CrossRefPubMed
69.
Chubak J, Kamineni A, Buist DSM, Anderson ML, Whitlock EP. Aspirin use for the prevention of colorectal cancer: an updated systematic evidence review for the U.S. Preventive Services Task Force. Evidence Synthesis No. 133. AHRQ Publication No. 15-05228-EF-1. Rockville: Agency for Healthcare Research and Quality; 2015.
70.
Dehmer SP, Maciosek MV, Flottemesch TJ, LaFrance AB, Whitlock EP. Aspirin for the primary prevention of cardiovascular disease and colorectal cancer: a decision analysis for the U.S. Preventive Services Task Force. Ann Intern Med. 2016;164:777–86.CrossRefPubMed
71.
American Gastroenterological Association. Consensus development conference on the use of nonsteroidal anti-inflammatory agents, including cyclooxygenase-2 enzyme inhibitors and aspirin. Clin Gastroenterol Hepatol. 2006;4:1082–9.CrossRef
72.
Salinas CA, Kwon EM, FitzGerald LM, Feng Z, Nelson PS, Ostrander EA, Peters U, Stanford JL. Use of aspirin and other nonsteroidal antiinflammatory medications in relation to prostate cancer risk. Am J Epidemiol. 2010;172:578–90.CrossRefPubMedPubMedCentral
73.
Slattery ML, Lundgreen A, Hines LM, Torres-Mejia G, Wolff RK, Stern MC, John EM. Genetic Variation in the JAK/STAT/SOCS signaling pathway influences breast cancer-specific mortality through interaction with cigarette smoking and use of aspirin/NSAIDs: the Breast Cancer Health Disparities Study. Breast Cancer Res Treat. 2014;147:145–58.CrossRefPubMedPubMedCentral
74.
Liao X, Lochhead P, Nishihara R, Morikawa T, Kuchiba A, Yamauchi M, Imamura Y. Aspirin use, tumor PIK3CA mutation, and colorectal-cancer survival. N Engl J Med. 2012;367:1596–606.CrossRefPubMedPubMedCentral
75.
Domingo E, Church DN, Sieber O, Ramamoorthy R, Yanagisawa Y, Johnstone E, Davidson B, Kerr DJ, Tomlinson IP, Midgley R. Evaluation of PIK3CA mutation as a predictor of benefit from nonsteroidal anti-inflammatory drug therapy in colorectal cancer. J Clin Oncol. 2013;31:4297–305.CrossRefPubMed
76.
Nishihara R, Lochhead P, Kuchiba A, Jung S, Yamauchi M, Liao X, Imamura Y, Qian ZR, Morikawa T, Wang M, Spiegelman D, Cho E, Giovannucci E, Fuchs CS, Chan AT, Ogino S. Aspirin use and risk of colorectal cancer according to BRAF mutation status JAMA. 2013;309:2563–71.PubMed
77.
Barry EL, Mott LA, Sandler RS, Ahnen DJ, Baron JA. Variants downstream of the ornithine decarboxylase gene influence risk of colorectal adenoma and aspirin chemoprevention. Cancer Prev Res. 2011;4:2072–82.CrossRef
78.
Salinas CA, Kwon EM, FitzGerald LM, Feng Z, Nelson PS, Ostrander EA, Peters U, et al. Stanford Association of aspirin and non-steroidal anti-inflammatory drug use with risk of colorectal cancer according to genetic variants JAMA. 2015;17(313):1133–42.
79.
Slattery ML, Lundgreen A, Welbourn B, Corcoran C, Wolff RK. Genetic variation in selenoprotein genes, lifestyle, and risk of colon and rectal cancer. PLoS One. 2012;7:e37312.CrossRefPubMedPubMedCentral
80.
Mora S, Ames JM, Manson JE. Low-dose aspirin in the primary prevention of cardiovascular disease: shared decision making in clinical practice. JAMA. 2016;316:709–10.CrossRefPubMed
81.
Goldstein LB, Bushnell CD, Adams RJ, Appel LJ, Braun LT, Chaturvedi S, American Heart Association Stroke Council, et al. Guidelines for the primary prevention of stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42:517–84.CrossRefPubMed
82.
Patrono C. Low-dose aspirin in primary prevention: cardioprotection, chemoprevention, both, or neither? Eur Heart J. 2013;34:3403–11.CrossRefPubMed
83.
Halvorsen S, Andreotti F, ten Berg JM, et al. Aspirin therapy in primary cardiovascular disease prevention: a position paper of the European Society of Cardiology working group on thrombosis. J Am Coll Cardiol. 2014;64:319–27.CrossRefPubMed
84.
Connolly SJ, Eikelboom JW, Ng J, et al. Net clinical benefit of adding clopidogrel to aspirin therapy in patients with atrial fibrillation for whom vitamin K antagonists are unsuitable. Ann Intern Med. 2011;155:579–86.CrossRefPubMed
85.
Volpe M, Abrignani MG, Borghi C, et al. Italian intersocietary consensus document on aspirin therapy in primary cardiovascular prevention [article in Italian]. G Ital Cardiol. 2014;15:442–51.
86.
Thun MJ, Jacobs EJ, Patrono C. The role of aspirin in cancer prevention. Nat Rev Clin Oncol. 2012;9:259–67.CrossRefPubMed
87.
De Berardis G, Sacco M, Evangelista V, et al. Aspirin and Simvastatin Combination for Cardiovascular Events Prevention Trial in Diabetes (ACCEPT-D). Trials. 2007;8:21.CrossRefPubMedPubMedCentral
88.
89.
90.
Nelson M, Reid C, Beilin L, et al. Rationale for a trial of low-dose aspirin for the primary prevention of major adverse cardiovascular events and vascular dementia in the elderly: Aspirin in Reducing Events in the Elderly (ASPREE). Drugs Aging. 2003;20:897–903.CrossRefPubMed
Metadata
Title
Aspirin and the Primary Prevention of Cardiovascular Diseases: An Approach Based on Individualized, Integrated Estimation of Risk
Authors
Massimo Volpe
Allegra Battistoni
Giovanna Gallo
Roberta Coluccia
Raffaele De Caterina
Publication date
01-09-2017
Publisher
Springer International Publishing
Published in
High Blood Pressure & Cardiovascular Prevention / Issue 3/2017
Print ISSN: 1120-9879
Electronic ISSN: 1179-1985
DOI
https://doi.org/10.1007/s40292-017-0213-4

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