Evaluation of Provider Implementation of the 2019 American College of Cardiology and American Heart Association Aspirin for Primary Prevention Guideline Recommendations for Older People

Design Retrospective chart review study using electronic medical record data from Inova Health System patients. Setting All cardiology, endocrinology, and primary care outpatient clinics operated by Inova Medical Group (IMG) in Northern Virginia. Participants Participants included were 70 years of age or older and taking aspirin 81 mg as of April 1, 2019. They had completed at least one visit with an IMG provider in primary care, cardiology, or endocrinology clinics between April 1, 2019, and February 17, 2020. Main Outcome Measures The primary outcome of this study was percentage of older people seen by a primary care physician, cardiologist, or endocrinologist since guideline publication who were continued on aspirin for primary prevention. Results The percentage of participants continued on aspirin for primary prevention was 92% versus 8.0% who were discontinued (P < 0.0001). Differences in subgroup analyses based on smoking history, diagnosis of diabetes, or history of venous thromboembolism were not statistically significant. Conclusion There was a significantly greater rate of aspirin continuation versus discontinuation among patients 70 years of age and older in the setting of primary cardiovascular prevention. Based on this result, most primary care physicians, endocrinologists, and cardiologists at this institution have chosen to continue aspirin in older people following the 2019 American College of Cardiology/American Heart Association guideline statement publication.

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American College of Cardiology and American Heart Association: guideline on the primary prevention of cardiovascular disease

British Journal of Cardiac Nursing ◽

10.12968/bjca.2020.0058 ◽

2020 ◽

Vol 15 (6) ◽

pp. 1-6

Author(s):

Belinda Linden

Keyword(s):

Cardiovascular Disease ◽

Cardiovascular Risk ◽

Primary Prevention ◽

American Heart Association ◽

American Heart ◽

Heart Association ◽

American Heart Association Guideline ◽

Cardiovascular Nursing ◽

Prevention Of Cardiovascular Disease

Belinda Linden presents a quarterly overview of recently published guidance of relevance to cardiovascular nursing. A guideline on reducing cardiovascular risk through primary prevention in adults is reviewed in this update.

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Coronary Artery Calcium for Personalized Allocation of Aspirin in Primary Prevention of Cardiovascular Disease in 2019

Circulation ◽

10.1161/circulationaha.119.045010 ◽

2020 ◽

Vol 141 (19) ◽

pp. 1541-1553 ◽

Cited By ~ 12

Author(s):

Miguel Cainzos-Achirica ◽

Michael D. Miedema ◽

John W. McEvoy ◽

Mahmoud Al Rifai ◽

Philip Greenland ◽

...

Keyword(s):

Cardiovascular Disease ◽

Coronary Artery ◽

Relative Risk ◽

Primary Prevention ◽

American Heart Association ◽

Relative Risk Reduction ◽

American Heart ◽

Heart Association ◽

Risk Of Bleeding ◽

Ascvd Risk

Background: Recent American College of Cardiology/American Heart Association Primary Prevention Guidelines recommended considering low-dose aspirin therapy only among adults 40 to 70 years of age who are at higher atherosclerotic cardiovascular disease (ASCVD) risk but not at high risk of bleeding. However, it remains unclear how these patients are best identified. The present study aimed to assess the value of coronary artery calcium (CAC) for guiding aspirin allocation for primary prevention by using 2019 aspirin meta-analysis data on cardiovascular disease relative risk reduction and bleeding risk. Methods: The study included 6470 participants from the MESA Study (Multi-Ethnic Study of Atherosclerosis). ASCVD risk was estimated using the pooled cohort equations, and 3 strata were defined: <5%, 5% to 20%, and >20%. All participants underwent CAC scoring at baseline, and CAC scores were stratified as =0, 1 to 99, ≥100, and ≥400. A 12% relative risk reduction in cardiovascular disease events was used for the 5-year number needed to treat (NNT 5 ) calculations, and a 42% relative risk increase in major bleeding events was used for the 5-year number needed to harm (NNH 5 ) estimations. Results: Only 5% of MESA participants would qualify for aspirin consideration for primary prevention according to the American College of Cardiology/American Heart Association guidelines and using >20% estimated ASCVD risk to define higher risk. Benefit/harm calculations were restricted to aspirin-naive participants <70 years of age not at high risk of bleeding (n=3540). The overall NNT 5 with aspirin to prevent 1 cardiovascular disease event was 476 and the NNH 5 was 355. The NNT 5 was also greater than or similar to the NNH 5 among estimated ASCVD risk strata. Conversely, CAC≥100 and CAC≥400 identified subgroups in which NNT 5 was lower than NNH 5 . This was true both overall (for CAC≥100, NNT 5 =140 versus NNH 5 =518) and within ASCVD risk strata. Also, CAC=0 identified subgroups in which the NNT 5 was much higher than the NNH 5 (overall, NNT 5 =1190 versus NNH 5 =567). Conclusions: CAC may be superior to the pooled cohort equations to inform the allocation of aspirin in primary prevention. Implementation of current 2019 American College of Cardiology/American Heart Association guideline recommendations together with the use of CAC for further risk assessment may result in a more personalized, safer allocation of aspirin in primary prevention. Confirmation of these findings in experimental settings is needed.

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The Use of Sex-Specific Factors in the Assessment of Women’s Cardiovascular Risk

Circulation ◽

10.1161/circulationaha.119.043429 ◽

2020 ◽

Vol 141 (7) ◽

pp. 592-599 ◽

Cited By ~ 9

Author(s):

Anandita Agarwala ◽

Erin D. Michos ◽

Zainab Samad ◽

Christie M. Ballantyne ◽

Salim S. Virani

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Primary Prevention ◽

American Heart Association ◽

American Heart ◽

Heart Association ◽

The United States ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Increased Risk

Cardiovascular disease (CVD) is the leading cause of death among women in the United States. As compared with men, women are less likely to be diagnosed appropriately, receive preventive care, or be treated aggressively for CVD. Sex differences between men and women have allowed for the identification of CVD risk factors and risk markers that are unique to women. The 2018 American Heart Association/American College of Cardiology Multi-Society cholesterol guideline and 2019 American College of Cardiology/American Heart Association guideline on the primary prevention of CVD introduced the concept of risk-enhancing factors that are specific to women and are associated with an increased risk of incident atherosclerotic CVD in women. These factors, if present, would favor more intensified lifestyle interventions and consideration of initiation or intensification of statin therapy for primary prevention to mitigate the increased risk. In this primer, we highlight sex-specific CVD risk factors in women, stress the importance of eliciting a thorough obstetrical and gynecological history during cardiovascular risk assessment, and provide a framework for how to initiate appropriate preventive measures when sex-specific risk factors are present.

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