Aspirin may help reduce risk of second heart attack, study finds, but less than half of eligible adults use it CNN (2023)

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For adults who have survived a heart attack or stroke,take aspirin regularly may reduce the risk of a new cardiovascular event. But a new study suggests that less than half of these heart disease patients worldwide take aspirin to prevent a new event.

Of the people with a history of cardiovascular disease surveyed in the new study, only about 40% reported taking aspirin to prevent another heart attack, stroke or cardiovascular event.

The percentage of patients using aspirin to reduce the risk of a secondary event varied by country, ranging from 16.6% in low-income countries such as Afghanistan, Benin and Ethiopia to 65% in high-income countries such as the Czech Republic and the United Kingdom. and the US, according to the study published Tuesday in 2013medical journal JAMA.

“We expected aspirin use for secondary prevention to be much higher. Most importantly, I think there's a global focus on improving cardiovascular health in general, and one of the efforts is improving the use of some of these evidence-based drugs," said Dr. Sang Gune Yoo, author and researcher of the study. in cardiovascular disease in the cardiovascular department of Washington University School of Medicine in St.

Secondary prevention refers to the use of aspirin to reduce the risk of a second heart attack or another stroke. It is different from primary prevention - using aspirin to reduce the risk of a first heart attack or stroke.

Unlike primary prevention, where aspirin's risk-benefit ratio isn't as clear-cut, research on secondary prevention shows that the benefits of taking aspirin far outweigh the risks for people who have had a heart attack or stroke.

The World Health Organization has onetarget for at least 50% of eligible peopleget some form of drug therapy and counseling to prevent heart attacks and strokes.

Cardiovascular diseases are the leading cause of death worldwide, claiming approximately 18 million lives each year.According to WHO. It is estimated that more than four out of five deaths from cardiovascular disease are caused by heart attacks and strokes. Whyaspirin helps thin the blood, which can help reduce the risk of blockages in the arteries that can cause a heart attack or stroke.

"What our study highlights is that, despite efforts to improve cardiovascular health worldwide, aspirin is still underused in secondary prevention," says Yoo. "Given that aspirin remains the number one cause of death, it is very important that health care systems and countries develop strategies to improve the use of aspirin and other cardiovascular drugs."

Where is aspirin used?

For the new study, Yoo and his colleagues from the University of Washington, the University of Michigan and other institutions around the world analyzed data from 51 countries where surveys were conducted between 2013 and 2020. Seven of the surveys were conducted in low-income countries. , 23 in lower-middle-income countries, 14 in upper-middle-income countries and seven in high-income countries.

The surveys included responses from more than 124,500 adults ages 40 to 69 who reported a history of cardiovascular disease and aspirin use. More than 10,500 of them reported cardiovascular disease.

When researchers examined aspirin use among people with a history of cardiovascular problems, they found that in low-income countries, 16.6% took aspirin to prevent a new event; in lower middle income countries it was 24.5%; in the upper middle income countries it was 51.1%; and in high-income countries it was 65%.

"To the best of our knowledge, the current study provides the most comprehensive and current estimates of global aspirin use for secondary prevention of cardiovascular disease," the researchers wrote, using the abbreviation for cardiovascular disease.

"Our findings revealed marked disparities around the world, as illustrated by the four times greater use of aspirin for secondary prevention of cardiovascular disease in high-income countries compared to low-income countries," they wrote. “None of the 30 low-income or lower-middle-income countries in our sample met the WHO target of at least 50% of eligible persons with a history of cardiovascular disease using aspirin. Only about half of the upper-middle-income and high-income countries included in our analysis have achieved this goal.”

Yoo said the study didn't look at why there were such differences in low aspirin use, and said more research is needed to determine whether this is related to access, providers not recommending aspirin or other factors.

Among people with a history of cardiovascular disease, aspirin use was greater among those who were older, male, had a higher level of education and lived in urban areas, the researchers found.

The researchers say their findings suggest that aspirin is underused as a low-cost tool for the secondary prevention of cardiovascular disease worldwide. In the United States, low-dose aspirin is available without a prescriptioncan cost as little as $5 to $10.

Who Should Take Aspirin?

“We live in an era where we have amazing, proven therapies that are effective in reducing the risk of cardiovascular events, and despite the abundance of evidence supporting their use, we use many lifesaving drugs suboptimally. And this is just one example,” said Dr. Jeffrey Berger, director of the Center for the Prevention of Cardiovascular Disease at NYU Langone Heart in New York, who was not involved in the new study.

He added that many people with cardiovascular disease who could benefit from regular exercise and a healthy diet also fail to adhere to these practices, just as they cannot take aspirin for secondary prevention.

“Aspirin has been around for over a century. It has been shown to be effective in reducing the risk of a cardiovascular event by about 40 years, over a period of forty years or more. I think people forget about the overwhelming data that supports its use," said Berger, who is also an associate professor at NYU's Grossman School of Medicine.

“Unfortunately, sometimes there is a misunderstanding between patients and healthcare providers,” he said. "I think there's a lot of uncertainty about who should take aspirin for prevention of a first heart attack or stroke."

OThat is the advice of the US Preventive Services Task Forceagainst adults aged 60 years and older starting low-dose aspirin for the primary prevention of cardiovascular disease and for persons aged 40 to 59 years who have a risk of cardiovascular disease of 10% or more over a ten-year period, leave the decision to doctors and patients. But this is very different from someone with a history of cardiovascular disease who takes aspirin to prevent a second heart attack or stroke.

"Aspirin is a double-edged sword," Dr. Erin Michos, associate director of preventive cardiology at Johns Hopkins Medicine in Baltimore, wrote via email.

“It can reduce the risk of thrombosis, but carries an increased risk of bleeding, giving it a narrower therapeutic window. 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 a heart attack, coronary revascularization or stroke, are at greater risk for a recurrent vascular event, so they are at higher vascular risk and therefore derive a greater net benefit from aspirin." she said.

For someone who does not have cardiovascular disease, the absolute risks of vascular events such as heart attack or stroke are lower, but the risks of bleeding are still similar.

So for most healthy adults who take aspirin for primary prevention, "aspirin may do more harm than good," Michos said. "However, the current paper shows that aspirin is still severely underused worldwide when it comes to secondary prevention, especially in low-income countries."