A Note From Your Pharmacist: Aspirin for Primary Prevention of CV Events
I recently had a discussion about the use of aspirin for primary prevention of cardiovascular (CV) events with your patient, _____________________________. I encouraged a discussion with you to clarify if it is appropriate for him/her to take low-dose aspirin (81 mg/day) as primary prevention.
We are getting lots of questions about using aspirin, as guidelines are catching up to the evidence. The latest guidance from the American College of Cardiology (ACC) and American Heart Association (AHA) highlights the need to think twice before recommending, prescribing, or using aspirin for primary prevention of CV events. In most primary prevention patients, aspirin is no longer recommended.
The risks of using aspirin for primary prevention of CV events outweigh the benefits in the following patients:
- Over the age of 70 years old.
- With an elevated bleeding risk (e.g., prior gastrointestinal [GI] bleed, chronic use of NSAIDs, use of an anticoagulant).
New guidelines recommend individualizing decision making for other patients, as the margin between CV benefit and bleeding risk is very small. For example, aspirin’s CV benefits are nearly a “wash” in primary prevention patients with diabetes. Using aspirin for about seven years may avoid a CV event in one in 90 patients, at the cost of life-threatening bleeding in one in 110 patients. Base decisions about using aspirin for primary prevention of CV events on:
- An assessment of CV and bleeding risk.
- Patient preferences and fears such as increased risk of heart attack or ischemic stroke versus a gastrointestinal bleed, willingness to take an additional med, etc.
We are continuing to encourage patients to lower their CV risk with other strategies, as appropriate:
- Lifestyle modifications (e.g., healthy eating, exercise, smoking cessation, weight loss).
- Optimize control of other conditions (e.g., blood pressure, cholesterol, diabetes).
Please feel free to contact me if you have any questions, or if I can assist with any medication needs for your patients.