Aspirin Best For Primary Prevention In Patients With High CA
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Aspirin has anti-clotting properties and is widely prescribed for secondary prevention in patients who have already had cardiovascular events, such as a heart attack or ischemic stroke. However role of aspirin in primary prevention of cardiovascular diseases like heart attacks and strokes has been unclear, A new study by UT Southwestern researchers could give doctors and patients more concrete guidelines for making this important decision.

This study aimed to examine the association between CAC, bleeding, and ASCVD and explore the net estimated effect of aspirin at different CAC thresholds.

Prospective population-based cohort study of Dallas Heart Study participants, free from ASCVD and not taking aspirin at baseline were included.

Overall, about half of the participants had a CAC score of 0, suggesting little to no calcium buildup in their arteries. About 7 percent had a CAC score of more than 100, suggesting heavy calcium buildup. The rest had values in the middle (1-99).

Major bleeding and ASCVD events were identified from International Statistical Classification of Diseases and Related Health Problems, Ninth Revision codes. Meta-analysis–derived aspirin effect estimates were applied to observed ASCVD and bleeding rates to model the net effect of aspirin at different CAC thresholds.

Results:
-- A total of 2191 participants had 116 major bleeding and 123 ASCVD events over a median follow-up of 12.2 years.

-- Higher CAC categories were associated with both ASCVD and bleeding events, but the association between CAC and bleeding was attenuated after multivariable adjustment.

-- Applying meta-analysis estimates, irrespective of CAC, aspirin use was estimated to result in net harm in individuals at low and intermediate 10-year ASCVD risk and net benefit in those at high ASCVD risk.

-- Among individuals at lower bleeding risk, a CAC score of at least 100 identified individuals who would experience net benefit, but only in those at borderline or higher 10-year ASCVD risk.

-- In individuals at higher bleeding risk, there would be net harm from aspirin irrespective of CAC and ASCVD risk.

Conclusively, higher CAC is associated with both ASCVD and bleeding events, with a stronger association with ASCVD. A high CAC score identifies individuals estimated to derive net benefit from primary prevention aspirin therapy from those who would not, but only in the setting of lower bleeding risk and estimated ASCVD risk that is not low.

Source: https://jamanetwork.com/journals/jamacardiology/article-abstract/2772390
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