Aspirin for Cardiovascular Event Prevention

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Table of Contents

Abstract
Introduction
Methods
Annotated Bibliography
Conclusion and Recommendations
References

Abstract

The appropriate use of low-dose aspirin may be regarded as highly beneficial for the primary and secondary prevention of cardiovascular accidents. The paper is dedicated to the examination of the possibility of the daily use of 81mg low-dose aspirin for women under age 60 to reduce the future risk of stroke compared with no usage of low-dose aspirin. As the research method, the critical review of literature related to the examination of the benefits and risks of aspirin use in cardiovascular event prevention was chosen. According to the results of the study, if the risk of bleeding is not expected and the risk of cardiovascular incidents exists for more than ten years, the use of low-dose aspirin will be beneficial for senior women’s health.

Introduction

Aspirin may be regarded as a highly efficient and accessible prophylactic medication that may substantially reduce the potential risks of cardiovascular events. Both primary and secondary prevention are significant for individuals with major risk factors, senior patients, and people with serious chronic diseases. The problem of the paper relates to the possibility of the daily use of 81mg low-dose aspirin (I) for women under age 60 (P) to reduce the future risk of stroke (O) compared with no usage of low-dose aspirin (C). According to the National Institute of Nursing Research (NINR), high blood pressure, stroke, coronary artery disease, atherosclerosis, and heart attacks are the main causes of death for women in the United States (National Institute of Nursing Research, n.d.). The ignorance of this highly disturbing situation may lead to increased death rates. That is why the in-depth examination of a mentioned problem may provide recommendations for clinicians and advanced nurse practitioners in order to reduce women’s cardiovascular incidents.

Methods

A literature search was conducted in electronic databases on the basis of keywords, such as “women,” “senior,” “low-dose aspirin,” “risk of stroke,” and “cardiovascular events.” The 2016-2019 timeframe of articles was chosen due to the significance of updated results of the researches dedicated to the defined problem. In general, there were a substantial number of articles related to the use of aspirin, however, the number of studies concerning the impact of aspirin therapy in cardiovascular event prevention was limited. All reviewed articles were chosen on the basis of their relevance as they contain essential evidence-based findings related to aspirin’s prevention of stroke and other cardiovascular accidents in senior male and female patients.

Annotated Bibliography

Carlton, R., Coppolecchia, R., Khalaf-Gillard, K., Lennert, B., Moradi, A., Williamson, T., & Cameron, J. (2018). Budget impact of appropriate low-dose aspirin use for primary and secondary cardiovascular event prevention in the managed care setting. Journal of Managed Care & Specialty Pharmacy, 24(11), 1102-1111.

The appropriate use of low-dose aspirin is not only highly beneficial for the prevention of cardiovascular events in the future but cost-effective as well. Carlton et al. (2018) conducted research to evaluate the medical effectiveness and budget impact of this therapy. For the current research, an economic model and a hypothetical plan that addressed 1 million members were developed and applied. Participants for the study were chosen with the use of the randomized sampling method. According to clinical practice, approximately 18,000 and 48,600 patients received aspirin therapy for primary and secondary cardiovascular event prevention, respectively (Carlton et al., 2018). On the basis of critical analysis of their results, certain findings were presented.

According to the treatment results, aspirin may have a positive impact on patients’ condition. Its optimal use for the primary prevention of cardiovascular events reduced the total number of ischemic strokes (-232), nonfatal myocardial infarctions (-367), and deaths (-60) (Carlton et al., 2018). In turn, the use of low-dose aspirin for secondary cardiovascular event prevention resulted in a more substantial reduction of negative health outcomes in comparison with the previous therapy.

This research supports the hypothesis that aspirin may be regarded as a simple prophylactic measure that helps to prevent cardiovascular incidents with substantial cost savings for patients. However, the patients’ age and gender were not specified as the research additionally aims to evaluate the cost-effectiveness of the low-dose aspirin use for ordinary U.S. payers. This study’s findings are immeasurably significant for the paper’s topic and for contemporary medicine as “cardiovascular disease remains the leading cause of death in adults in the United States” (Carlton et al., 2018, p. 1102). Concerning the research, it may be highly beneficial for the further evaluation of the aspirin use’s impact on various groups of patients.

Raber, I., McCarthy, C. P., Vaduganathan, M., Bhatt, D. L., Wood, D. A., Cleland, J. G. F., … McEvoy, J. W. (2019). The rise and fall of aspirin in the primary prevention of cardiovascular disease. Lancet, 393, 2155-2167.

Another study that aims to examine the influence of aspirin on the prevention of negative health conditions was presented by Raber et al. (2019). The authors of the article gathered the results of multiple previous and contemporary trials in order to estimate the viability of aspirin use. Data was provided by the recent study’s clinician results of 164225 women and men both healthy and with substantial cardiovascular risks (Raber et al., 2019). Participants for the study were chosen with the use of the randomized sampling method.

The major findings of this research demonstrate the efficiency of aspirin use in secondary prevention. At the same time, the role of aspirin for primary cardiovascular event prevention may be regarded as highly controversial. While this medication reduces the potential risk of stroke and myocardial infarction, it increases the possibility of gastrointestinal or intracranial bleeding (Raber et al., 2019). According to their results, aspirin helps to reduce “the composite outcome of cardiovascular mortality, non-fatal myocardial infarction, and non-fatal stroke (HR 0,89, 95% CI 0,84–0,95) ), with an absolute risk reduction of 0,38%” (Raber et al., 2019, p. 2161). At the same time, absolute risk and the rate of bleeding events were increased. In addition, the primary prevention project (PPP) aimed to investigate the role of aspirin in the treatment of patients with cardiovascular risk factors (Raber et al., 2019). It showed a 23% reduction in cardiovascular events and a 44% reduction in total cardiovascular death rate after four years (Raber et al., 2019). From this perspective, the positive influence of low-dose aspirin on the patient’s health may be insignificant at the beginning of therapy, however, it will be observed after several years.

Concerning the effect of sex, the results of trials that had used the data of exceptionally female patients were controversial as well. While early subgroup analysis illustrated different effects of low-dose aspirin on women and men, recent well-conducted researches subsequently did not find sex-stratified differences (Raber et al., 2019). Nevertheless, the benefits of aspirin for women were demonstrated by the women’s health study (WHS) (Raber et al., 2019). Even though the trial’s primary endpoint was not met, the incidence of a nonfatal and fatal stroke was eventually reduced by 17% (Raber et al., 2019).

This research supports the hypothesis that aspirin use may reduce the risk of cardiovascular events and the impact of this medicine is determined by the patient’s sex. In general, the study may be characterized by information exhaustiveness as it includes the description of various researches conducted with age-diverse patients. Its significance is determined by the fact that “aspirin is one of the most frequently used drugs worldwide and is generally considered effective for the secondary prevention of cardiovascular disease” (Raber et al., 2019, p. 2155). Further studies may focus on the potential minimization of aspirin’s side effects in primary prevention.

Capodanno, D., & Angiolillo, D. J. (2016). Aspirin for primary cardiovascular risk prevention and beyond in diabetes mellitus. Circulation, 134(20), 1579-1594.

Another well-elaborated and complex study dedicated to the potential advantages and disadvantages of aspirin therapy for patients with diabetes was conducted by Capodanno and Angiolillo (2016). Data were collected from fifteen clinical trials that involved both healthy women and men and patients with various risk factors. Trials were conducted between 1988 and 2014 in order to investigate the impact of acetylsalicylic acid for primary cardiovascular event prevention (Capodanno & Angiolillo, 2016). Patients for the study were chosen with the use of the randomized sampling method.

The findings of this research support the results of previously reviewed studies – the value of low-dose aspirin for primary prevention is substantively controversial. The authors addressed particular concerns that the therapy’s modest benefits do not compensate for increased gastrointestinal and intracranial hemorrhage (Capodanno & Angiolillo, 2016). The total result of these studies demonstrated a 23% reduction in nonfatal myocardial infarction and the absence of aspirin effect on vascular mortality and ischemic stroke. In addition, aspirin reportedly reduced stroke in women and cardiovascular accidents in men. In turn, the benefits of acetylsalicylic acid for secondary prevention “have been repeatedly and convincingly demonstrated to outweigh the risk of bleeding” (Capodanno & Angiolillo, 2016, p. 1579). At the same time, the authors mentioned numerous conflicting recommendations related to the safety of aspirin use for primary prevention.

According to the results of the research that addresses the European Society of Cardiology and the European Association for the Study of Diabetes, aspirin therapy is not recommended for primary cardiovascular accident prevention in patients with diabetes and without overt cardiovascular diseases (Capodanno & Angiolillo, 2016). However, the Working Group on Thrombosis approves the use of low-dose acetylsalicylic acid by patients if the increased risk of gastrointestinal and intracranial bleeding is not presupposed (Capodanno & Angiolillo, 2016). In general, a risk-based approach implies aspirin therapy for men and women with the risk of cardiovascular incidents that exists for more than ten years.

This article supports the evidence-based theory related to the efficacy of aspirin in the prevention of stroke and other cardiovascular events in patients with serious chronic diseases.

The significance of this research is justified as diabetes mellitus “has been associated with a substantially increased risk of both first and recurrent atherothrombotic events, which makes aspirin therapy of potential value in these subjects” (Capodanno & Angiolillo, 2016, p. 1579). Primary and secondary atherothrombosis prevention that may be regarded as an essential mechanism of ischemic stroke, nonfatal myocardial infarction, and death implies the use of specific pharmacologic agents that may counteract the clot formation process. That is why the antithrombotic potential of aspirin, or acetylsalicylic acid, as an antiplatelet agent is highly appreciated. The efficiency of aspirin use in the setting of other chronic diseases may be investigated in the future.

Patrono, C., & Baigent, C. (2019). Role of aspirin in primary prevention of cardiovascular disease. Nature Reviews Cardiology, 16, 675-686.

Similar to previously reviewed studies, the research conducted by Patrono and Baigent (2019) admitted the controversial impact of aspirin use in primary cardiovascular incident prevention as well. The authors collected data from the most fundamental study dedicated to the issue of aspirin effect that included 17000 age-diverse patients and 3306 serious vascular events, Patients for the study were chosen with the use of the randomized sampling method.

According to the major findings of the study, aspirin therapy may be destructive for elderly patients with major risk factors. For instance, the ASPREE trial in senior patients was prematurely terminated due to the substantively increased risk of bleeding and all-cause mortality in the framework of low-dose aspirin use (Patrono & Baigent, 2019). This article supports a highly significant theory that the patient’s age should be considered by a specialist before the prescription of aspirin therapy. This research may be used for the further investigation of the interrelatedness between the patient’s age and sex in the context of aspirin therapy.

Gargiulo, G., Windecker, S., Vranckx, P., Gibson, C. M., Mehran, R., & Valgimigli, M. (2016). A critical appraisal of aspirin in secondary prevention: Is less more? Circulation, 134(23), 1881-1906.

The investigation of the impact of aspirin therapy on the reduction of cardiovascular events in secondary prevention was made by Gargiulo et al. (2016). As a method of research, the critical review of available evidence was used. Data were collected from sixteen trials that involved patients with the acute coronary syndrome. Patients for the study were chosen with the use of the randomized sampling method.

In general, low-dose aspirin therapy demonstrated a substantial reduction in coronary events and total stroke (Gargiulo et al., 2016). However, the authors question the reliability of the trials’ results as they were conducted “several decades ago and do not reflect the modern-day clinical settings, therapeutics, and event rate” (Gargiulo et al., 2016, p. 1885).

That is why for further research the examination of the effect of sex or the update of existing results concerning this issue will be essential as well.

American Diabetes Association. (2018). Cardiovascular disease and risk management: Standards of Medical Care in Diabetes – 2018. Diabetes Care, 41(1), 86-104.

The American Diabetes Association (ADA) (2018) presented the research with well-elaborated standards of medical treatment in diabetes and the recommendations based on its current clinical practice. The study provides general treatment goals, the components of effective diabetes care, and tools for its evaluation. The ADA collected data from trials that involved age-diverse women and men with diabetes and substantive risk of cardiovascular incidents, and evidence from its clinical practice. Participants for the study were chosen with the use of the randomized sampling method.

According to the ADA (2018), aspirin therapy (75–162 mg/day) may be regarded as a highly efficient “secondary prevention strategy in those with diabetes and a history of atherosclerotic cardiovascular disease” (p. 95). However, similar to other researches, the association questions the usefulness of aspirin therapy for the primary prevention of cardiovascular incidents for people with and without diabetes.

According to the major findings of the ADA’s research, low-dose aspirin is generally not recommended for women and men aged under 50 years with diabetes who do not have additional risk factors as “the low benefit is likely to be outweighed by the risks of bleeding” (American Diabetes Association, 2018, p. 96). As the strategy of primary cardiovascular event prevention, aspirin therapy (75–162 mg/day) should be prescribed for senior patients, both women, and men, with type 1 or type 2 diabetes and additional risk factors (American Diabetes Association, 2018). These major factors traditionally include hypertension, albuminuria, smoking, dyslipidemia, or premature atherosclerotic cardiovascular disease in family history (American Diabetes Association, 2018). In addition, these patients should be not at substantial risk of bleeding as well. In addition, the patient’s sex has a particular influence on the results of aspirin use. While aspirin substantially reduces atherosclerotic cardiovascular events in men in comparison with women, it is more beneficial for women in the prevention of stroke.

The results of the research support the theory of aspirin’s different impact on men and women and the benefits of this medicine in secondary prevention. The significance of this study is determined by the fact that the prevention of stroke and other cardiovascular events is crucial for patients with additional severe chronic diseases. Further investigation of the impact of aspirin therapy on patients with other serious diseases may be initiated.

Conclusion and Recommendations

.In general, aspirin may be regarded as a simple prophylactic measure that helps to prevent cardiovascular incidents. Low-dose aspirin therapy demonstrated a substantial reduction in coronary events and total stroke. Particularly, it may be regarded as a highly efficient secondary prevention strategy in those with serious chronic diseases, such as diabetes, and a history of atherosclerotic cardiovascular disease. However, the value of low-dose aspirin for primary cardiovascular event prevention is highly controversial as the aspirin therapy’s modest benefits do not compensate for increased gastrointestinal and intracranial hemorrhage. As the strategy of primary cardiovascular event prevention, aspirin therapy should be prescribed for senior patients, both women, and men, with additional risk factors or serious diseases. In addition, the patient’s sex has a particular influence on the results of aspirin use – aspirin reportedly reduced stroke in women and cardiovascular accidents in men.

To sum up, for women under age 60 (P), the daily use of 81mg low-dose aspirin (I) may reduce the future risk of stroke (O) compared with no usage of low-dose aspirin (C). Female patients aged 50-70 years with a substantial risk of coronary heart disease, in particular, are more vulnerable to various cardiovascular incidents in comparison with young people. Moreover, aspirin is a highly efficient and accessible prophylactic medication that may substantially reduce the potential risks of cardiovascular events. For primary prevention, aspirin therapy should be used with reserve as this medication may increase the possibility of gastrointestinal or intracranial bleeding (Mora & Manson, 2016). Nevertheless, if the risk of hemorrhage is not expected, the risk of cardiovascular incidents exists for more than ten years, or stroke or myocardial infarction has already occurred, the use of low-dose aspirin will be beneficial for women’s health.

In general, advanced nurse practitioners may be as effective as physicians in the establishment and control of cardiovascular disease prevention. A systematic approach to cardiovascular incident risk reduction is supported through nurse-directed case management (Kruger, 2018). As competent health care providers, nurse practitioners are responsible for the delivery of multifactorial cardiovascular risk reduction in and community-based facilities, outpatient clinics, and hospital settings (Berra, Miller, & Jennings, 2011). The conducted research may be regarded as highly beneficial for the nursing practice as it contains essential information concerning potential risks of aspirin use. For nursing professionals, it is immeasurably significant to consider the patient’s age, sex, health condition, previous medical history, and additional acute or chronic diseases before the prescription of aspirin to avoid negative health outcomes.

References

American Diabetes Association. (2018). Cardiovascular disease and risk management: Standards of Medical Care in Diabetes – 2018. Diabetes Care, 41(1), 86-104.

Berra, K., Miller, N. H., & Jennings, C. (2011). Nurse-based models for cardiovascular disease prevention: From research to clinical practice. Journal of Cardiovascular Nursing, 26(4), 46-55.

Capodanno, D., & Angiolillo, D. J. (2016). Aspirin for primary cardiovascular risk prevention and beyond in diabetes mellitus. Circulation, 134(20), 1579-1594.

Carlton, R., Coppolecchia, R., Khalaf-Gillard, K., Lennert, B., Moradi, A., Williamson, T., & Cameron, J. (2018). Budget impact of appropriate low-dose aspirin use for primary and secondary cardiovascular event prevention in the managed care setting. Journal of Managed Care & Specialty Pharmacy, 24(11), 1102-1111. Web.

Gargiulo, G., Windecker, S., Vranckx, P., Gibson, C. M., Mehran, R., & Valgimigli, M. (2016). A critical appraisal of aspirin in secondary prevention: Is less more?Circulation, 134(23), 1881-1906.

Kruger, D. (2018). Cardiovascular outcome trials in type 2 diabetes: A nurse practitioner perspective. Journal of the American Association of Nurse Practitioners, 30, 43-52.

Mora, S., & Manson, J. E. (2016). Aspirin for primary prevention of atherosclerotic cardiovascular disease: Advances in diagnosis and treatment. JAMA Internal Medicine, 176(8), 1195-1204.

National Institute of Nursing Research. (n.d.). Subtle and dangerous: Symptoms of heart disease in women [PDF document]. Web.

Patrono, C., & Baigent, C. (2019). Role of aspirin in primary prevention of cardiovascular disease. Nature Reviews Cardiology, 16, 675-686.

Raber, I., McCarthy, C. P., Vaduganathan, M., Bhatt, D. L., Wood, D. A., Cleland, J. G. F., … McEvoy, J. W. (2019). The rise and fall of aspirin in the primary prevention of cardiovascular disease. Lancet, 393, 2155-2167.

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