A study found that aspirin can help reduce the risk of a second heart attack, but less than half of eligible adults take it

CNN
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For adults who have survived a heart attack or stroke, Take aspirin regularly May reduce the risk of another cardiovascular event. But a new study suggests that less than half of patients with cardiovascular disease around the world use 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 a heart attack, stroke, or other cardiovascular event.

The proportion of patients using aspirin to reduce the risk of a secondary event varies by country, however, 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 United States, according to the study published Tuesday in the journal JAMA Medical Journal.

“We had hoped that the rates of aspirin use for secondary prevention would be much higher. I particularly think that in general, globally, there has been an emphasis on improving cardiovascular health, and one of the efforts is Improving the use of some of these evidence-based medications.” Cardiovascular Fellow in the Department of Cardiovascular Diseases at Washington University School of Medicine in St. Louis.

Secondary prevention refers to the use of aspirin to reduce the risk of a second or additional heart attack or stroke. It differs from primary prevention — using aspirin to reduce the risk of a first heart attack or stroke.

Unlike primary prevention, where the risk-benefit ratio of aspirin is not clear, available 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.

WHO has it Target at least 50% of these eligible persons To receive some kind of drug treatment and counseling to prevent heart attacks and strokes.

Cardiovascular diseases are the leading cause of death worldwide, claiming about 18 million lives each year. According to the World Health Organization. It is estimated that more than 4 out of 5 deaths from cardiovascular disease are due to heart attacks and strokes. because Aspirin helps thin the bloodwhich can help reduce the risk of clogged arteries that could cause a heart attack or stroke.

“What our study highlights is that despite efforts to improve cardiovascular health globally, aspirin is still not used adequately in secondary prevention,” Yu said. “As it continues to be the number one cause of death, it is very important that health systems and countries develop strategies for ways to improve the use of aspirin in addition to other cardiovascular medications.”

For the new study, Yu and 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 having cardiovascular disease.

When researchers examined aspirin use among people with a history of cardiovascular problems, they found that in low-income countries, 16.6% were taking aspirin to prevent another event. in lower-middle-income countries, it was 24.5%; in upper-middle-income countries it was 51.1%; In high-income countries, the figure is 65 percent.

“To our knowledge, the current study provides the most comprehensive and up-to-date estimate of global use of aspirin for secondary prevention of CVD,” the researchers wrote, using the acronym for cardiovascular disease.

“Our findings revealed significant disparities across the world, as evidenced by a fourfold increase in aspirin use for secondary prevention of CVD 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 individuals with a history of CVD taking aspirin. Nor did it meet this target Only about half of upper-middle-income and high-income countries included in our analysis.

Yu said the study did not analyze why there were such differences in low aspirin use, and said more research is needed to determine if it is related to accessibility, providers not recommending aspirin or other factors.

The researchers found that among people with a history of cardiovascular disease, there was greater use of aspirin in the elderly, males, those with higher education levels and those living in urban areas.

The researchers say their findings indicate that aspirin is underused as an inexpensive tool for secondary prevention of cardiovascular disease events globally. In the United States, low-dose aspirin is available without a prescription It can cost as little as $5 to $10.

“We live in a time when we have well-established treatments that are incredibly effective in reducing the risk of cardiovascular disease, and despite an abundance of evidence supporting their use, we are using many life-saving medications suboptimally,” said Dr. Jeffrey Berger, director of the Prevention Center. of cardiovascular disease at NYU Langone Hart in New York, who was not involved in the new study. “This is just one example.”

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

“Aspirin has been around for more than a century. It has been shown to be effective in reducing the risk of cardiovascular disease for nearly 40 years, over four decades or so. I think People forget the massive data that supports its use.”

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

the The US Preventive Services Task Force recommends: against adults 60 years of age and older, starting with low-dose aspirin for primary prevention of cardiovascular disease, and for people 40 to 59 years of age. Those with a risk of developing cardiovascular disease of 10% or more over 10 years, the decision is left 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 the division of preventive cardiology at Johns Hopkins Medicine in Baltimore, wrote in an email.

“It can reduce the risk of blood clots but that comes at the cost of an increased risk of bleeding, so its treatment window is narrower. There’s a delicate balance between the risk of blood clots and the risk of bleeding,” said Michos, who was not involved in the new study.

“People who have already experienced a cardiovascular event such as a heart attack, coronary revascularization or stroke are at increased risk of a recurrent vascular event, so they have a higher risk of vascularization and therefore derive a greater net benefit from aspirin,” she said.

For someone without cardiovascular disease, the absolute risks of vascular events such as a heart attack or stroke are lower, but the bleeding risks are still comparable.

For most healthy adults who take aspirin for primary prevention, Michos said, aspirin may cause more harm than good. However, it appears from the current article that worldwide aspirin is still underutilized in secondary prevention, especially in low-income countries.