P668Aspirin for primary prevention of cardiovascular disease

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
G Gelbenegger ◽  
M Postula ◽  
L Pecen ◽  
S Halvorsen ◽  
M Lesiak ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Disease ◽  
Relative Risk ◽  
Primary Prevention ◽  
Major Bleeding ◽  
Forest Plot ◽  
Bleeding Events ◽  
Benefit Risk Assessment ◽  
Increased Risk ◽  
Prevention Of Cardiovascular Disease

Abstract Background Platelet inhibition by aspirin reduces ischemic events but increases the risk of bleeding events. Yet, the role of aspirin in primary prevention of cardiovascular disease remains unclear. Purpose To produce a clinically relevant benefit-risk assessment of aspirin for primary prevention of cardiovascular disease. Methods We performed a meta-analysis of aspirin effects in primary prevention of cardiovascular disease comprising 13 randomized-controlled trials in 164.225 patients comparing aspirin versus placebo/control during a mean follow-up period of 6.4 years. Using a random effect model, relative risks and 95% confidence intervals were calculated for each outcome. Results Aspirin reduced the relative risk of ischemic stroke by 10% (RR: 0.90; 95% CI: 0.82–0.99), myocardial infarction by 14% (RR: 0.86; 95% CI: 0.77–0.95) and the major adverse cardiovascular events by 9% (RR: 0.91; 95% CI: 0.86–0.95) but was associated with a 46% relative risk increase of major bleeding events (RR: 1.46; 95% CI: 1.30–1.64). Aspirin did not reduce the risk of cardiovascular mortality (RR: 0.99; 95% CI: 0.90–1.08), all-cause mortality (RR: 0.98; 95% CI: 0.93–1.02) or cancer (RR 1.05; 95% CI, 0.87–1.26). Aspirin use did not translate into a net clinical benefit adjusted for event-associated mortality risk (mean 0.034%; 95% CI: −0.18 to 0.25%). Forest plot of major outcomes. Conclusions Aspirin use in primary prevention is associated with a reduced risk of stroke and myocardial infarction, but at a cost of an increased risk of major bleeding. Acknowledgement/Funding None

scholarly journals Plasma Resistin Levels and Risk of Myocardial Infarction and Ischemic Stroke

2008 ◽  
Vol 93 (7) ◽  
pp. 2647-2653 ◽  
Author(s):  
Cornelia Weikert ◽  
Sabine Westphal ◽  
Klaus Berger ◽  
Jutta Dierkes ◽  
Matthias Möhlig ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Disease ◽  
Ischemic Stroke ◽  
Relative Risk ◽  
Confidence Interval ◽  
High Plasma ◽  
Case Control Studies ◽  
Blood Draw ◽  
Increased Risk ◽  
Aged Subjects

Abstract Context: Resistin is a hormone that has been linked to insulin resistance, inflammatory processes, and coronary heart disease in case-control studies; however, prospective data on the association between plasma resistin levels and future risk of cardiovascular disease are lacking. Objective: The objective of the study was to investigate the association between plasma resistin levels and risk of future myocardial infarction (MI) and ischemic stroke (IS) in a large prospective cohort. Methods: We investigated the association between plasma resistin levels and risk of MI and IS in a case-cohort design among 26,490 middle-aged subjects from the European Investigation into Cancer and Nutrition-Potsdam Study without history of MI or stroke at time of blood draw. Plasma resistin levels were measured in baseline blood samples of 139 individuals who developed MI, 97 who developed IS, and 817 individuals who remained free of cardiovascular events during a mean follow-up of 6 yr. Results: After multivariable adjustment for established cardiovascular risk factors including C-reactive protein, individuals in the highest compared with the lowest quartile of plasma resistin levels had a significantly increased risk of MI (relative risk 2.09; 95% confidence interval 1.01–4.31; P for trend = 0.01). In contrast, plasma resistin levels were not significantly associated with risk of IS (relative risk 0.94; 95% confidence interval 0.51–1.73; P for trend = 0.88). Conclusion: Our data suggest that high plasma resistin levels are associated with an increased risk of MI but not with risk of IS. Further studies are needed to evaluate the predictive value of plasma resistin levels for cardiovascular disease.

scholarly journals Harms and Benefits of Using Aspirin for Primary Prevention of Cardiovascular Disease: A Narrative Overview

2018 ◽  
Vol 45 (02) ◽  
pp. 157-163 ◽  
Author(s):  
Elisa Danese ◽  
Emmanuel Favaloro ◽  
Giuseppe Lippi
Keyword(s):  
Cardiovascular Disease ◽  
Primary Prevention ◽  
The Elderly ◽  
Favorable Effect ◽  
Major Adverse Cardiovascular Events ◽  
Increased Risk ◽  
Group Randomized Trial ◽  
Meta Analyses ◽  
Group Trial ◽  
Prevention Of Cardiovascular Disease

AbstractAspirin is one of the most often used drugs for prevention and treatment of a variety of thrombotic disorders. This narrative review aims to provide an overview of evidence highlighting potential benefits and relative harms of aspirin in primary prevention of cardiovascular disease. The authors summarize key findings of the ASPirin in Reducing Events in the Elderly (ASPREE) Investigator Group randomized trial and also provide a comparative overview of recent meta-analyses. Overall, all-cause mortality was largely heterogeneous, with some meta-analyses showing a modestly decreased risk in patients taking aspirin, with others reporting no effects, but the ASPREE Investigator Group trial evidencing 14% higher risk. Regarding cardiovascular disease, the most favorable impact could be noted for major adverse cardiovascular events, with most meta-analyses reporting a decreased risk in people receiving aspirin. Conversely, the ASPREE Investigator Group trial demonstrated no significant impact of aspirin on risk of cardiovascular mortality or ischemic stroke. A modest favorable effect of aspirin in decreasing the risk of myocardial infarction was noted in two meta-analyses, but not in other reports or in the ASPREE Investigator Group trial. Furthermore, one meta-analysis reported a lower risk of future cancer, others failed to report a significant effect, and the ASPREE Investigator Group trial reported a 31% increased risk. Unlike these conflicting outcomes, the bleeding risk of patients receiving aspirin was found to be consistently enhanced in all reports reviewed. These recent findings would lead us to conclude that the harms of aspirin in primary prevention of cardiovascular disease may be larger than the benefits, especially in the elderly general population.

scholarly journals Aspirin for primary prevention of stroke in individuals without cardiovascular disease—A meta-analysis

2019 ◽  
Vol 15 (1) ◽  
pp. 9-17
Author(s):  
Conor Judge ◽  
Sarah Ruttledge ◽  
Robert Murphy ◽  
Elaine Loughlin ◽  
Sarah Gorey ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Disease ◽  
Primary Prevention ◽  
Gastrointestinal Bleeding ◽  
Odds Ratio ◽  
Hemorrhagic Stroke ◽  
Meta Analysis ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Fatal Myocardial Infarction

Background The benefits of aspirin for primary prevention of stroke are uncertain. Methods We performed a cumulative meta-analysis of trials investigating aspirin for primary prevention of cardiovascular disease with a focus on stroke. We assessed the effects of aspirin on non-fatal stroke, hemorrhagic stroke, non-fatal myocardial infarction, all-cause mortality, cardiovascular mortality, major gastrointestinal bleeding, and an analysis of net clinical effect, in populations without a history of clinical or subclinical cardiovascular disease. Summary of review results Among 11 trials (157,054 participants), aspirin was not associated with a statistically significant reduction in non-fatal stroke (odds ratio, 0.94; 95% CI, 0.85 to 1.04) but was associated with an increased risk of hemorrhagic stroke (odds ratio, 1.29; 95% CI, 1.06 to 1.56). Aspirin was not associated with a statistically significant reduction in all-cause mortality (odds ratio, 0.97; 95% CI, 0.92 to 1.03) or cardiovascular mortality (odds ratio, 0.94; 95% CI, 0.85 to 1.03). Aspirin was associated with a reduction in non-fatal myocardial infarction (odds ratio, 0.80; 95% CI, 0.69 to 0.94) and an increased risk of major gastrointestinal bleeding (odds ratio, 1.83; 95% CI, 1.43 to 2.35). Using equal weighting for non-fatal events and major bleeding, we observed no net clinical benefit with aspirin use for primary prevention. Conclusion Our meta-analysis reports no benefit of aspirin for primary stroke prevention.

Aspirin in the primary prevention of cardiovascular disease in individuals with chronic kidney disease: a systematic review and meta-analysis

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
S Pallikadavath ◽  
L Ashton ◽  
J Burton ◽  
N Brunskill ◽  
L Gray ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Chronic Kidney Disease ◽  
Primary Prevention ◽  
Kidney Disease ◽  
Meta Analysis ◽  
Minor Bleeding ◽  
Bleeding Events ◽  
All Cause Mortality ◽  
Randomised Controlled ◽  
Prevention Of Cardiovascular Disease

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Cardiovascular disease (CVD) is a major cause of morbidity and mortality in individuals with chronic kidney disease (CKD). Aspirin is widely used in secondary prevention of cardiovascular disease. Its use in primary prevention, particularly in CKD, is less clear. Previous reviews have offered inconclusive findings for the benefit of aspirin in CKD. Recent trials have been completed that may help provide more conclusive answers in CKD. Purpose This study aimed to assess the role of aspirin in the primary prevention of CVD and its associated adverse events in individuals with CKD. Methods A pre-defined protocol registered with PROSPERO (CRD42014008860) was used. The OVID Medline and EMBASE databases were searched for studies from 1996 to the 15th September 2020. Abstracts and full-texts were screened independently by two reviewers. Randomised controlled trials that compared aspirin to placebo in individuals with non-endstage CKD without CVD nor primary renal disease were included. The primary outcomes of interests were: CVD, major and minor bleeding events. Secondary outcomes of interest were: all-cause mortality, coronary artery disease and stroke. A meta-analysis was conducted using a random-effects model to calculate a pooled relative risk (RR). Results Five trials were included with 434 CVD events in 7,825 individuals with CKD. Aspirin offered no statistically significant benefit in reduction of CVD events (RR = 0.79, 95%CI: 0.57, 1.09) but significantly increased both minor (RR = 2.62, 95%CI: 1.64, 4.20) and major bleeding (RR= 1.51, 95%CI: 1.13, 2.02) events compared to placebo. Aspirin conferred no benefit for all-cause mortality (RR= 0.89, 95%CI: 0.64, 1.22), coronary heart disease (RR= 0.66, 95%CI: 0.27, 1.63) and stroke (RR= 0.94, 95%CI: 0.55, 1.58). Conclusion Aspirin cannot be recommended for the primary prevention of CVD in individuals with CKD as it offers no conclusive benefit and increases the risk of bleeding. Other strategies to optimise CVD primary prevention in individuals with CKD should be prioritised.

Stroke and myocardial infarction prevention with GLP1 analogues in high or very-high cardiovascular risk diabetic patients

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
D Cazorla-Morallon ◽  
A Cordero ◽  
A Pomares Varo ◽  
G Torroba Balmori ◽  
M.J Moreno Garcia ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Disease ◽  
Placebo Treatment ◽  
Fixed Effect Model ◽  
Forest Plot ◽  
Diabetic Patients ◽  
Stroke Incidence ◽  
Increased Risk ◽  
Glucagon Like Peptide 1 ◽  
Very High

Abstract Background Patients with established cardiovascular disease have an increased risk of stroke, even in the absence of atrial fibrillation. Several trials have analysed the effect of glucagon-like peptide-1 receptor (GLP1) analogues on cardiovascular events in patients with high cardiovascular disease. Methods We performed a metanalysis with all randomized clinical trial that compared a GLP1 analogue vs. placebo. Primary endpoint was stroke incidence, including ischemic and haemorrhagic aetiology, assessed by fixed-effect model. Results We identified 7 trials that compared a GLP analogue (albiglutide, dulaglutide, exenatide, liraglutide, lixinatide or semaglutide). A total of 56,004 patients were included in the analysis, 27977 treated with a GLP1 analogue. Mean age of the patients was 63.9 (2.1) years, 25,398 (45.4%) patients had cardiovascular disease. A total of 1,568 strokes were reported, 711 in patients receiving a GLP analogue and 857 in control arm; treatment with a GLP1 analogue reduced the incidence of stroke by 147% (RR: 0.83, 95% CI 0.75–0.92; p<0.001). No heterogeneity between trials was observed (p=0.835). Globally, treatment with GPL1 analogues reduced the incidence of stroke or myocardial infarction by 11% (RR: 0.89, 95% CI 0.84–0.94; p<0.01) A total of 3,192 cases of myocardial infarction were reported: 1,524 in patients treated with GLP1 analogues and 1,668 with placebo. Treatment with GLP1 analogues reduce the incidence of myocardial infarction by 8% (RR: 0.92, 95% CI 0.86–0.98; p=0.010) Conclusions Treatment with a GLP1 analogue reduced the incidence of stroke by 17% and myocardial infarction by 8%, in different trials involving high or very-high risk patients with diabetes. Forest plot: stroke and MI Funding Acknowledgement Type of funding source: None

Primary Prevention of Cardiovascular Disease

2009 ◽  
Vol 42 (19) ◽  
pp. 37
Author(s):  
WILLIAM E. GOLDEN ◽  
ROBERT H. HOPKINS
Keyword(s):  
Cardiovascular Disease ◽  
Primary Prevention ◽  
Prevention Of Cardiovascular Disease
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