Aspirin for Primary Prevention of Cardiovascular Events in the Elderly Current Status and Future Directions

The role of aspirin in the secondary prevention of occlusive cardiovascular events has now been well established. Given this, aspirin in primary prevention has been the focus of several large trials and subsequent meta-analyses over the past 3 decades, and yet the issue remains controversial. Recent...

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Published in:	Drugs & aging Vol. 29; no. 4; pp. 251 - 258
Main Authors:	Ward, Stephanie A., Demos, Lisa, Workman, Barbara, McNeil, John J.
Format:	Journal Article
Language:	English
Published:	Cham Springer International Publishing 01.04.2012 Adis International
Subjects:	Aged Aspirin - pharmacology Biological and medical sciences Cardiovascular Diseases - prevention & control Current Opinion Geriatrics/Gerontology Humans Internal Medicine Medical sciences Medicine Medicine & Public Health Pharmacology. Drug treatments Pharmacology/Toxicology Pharmacotherapy Practice Guidelines as Topic Randomized Controlled Trials as Topic Prasugrel Aspirin Primary Prevention Ischaemic Stroke Ticagrelor Human Prostaglandin-endoperoxide synthase Enzyme Enzyme inhibitor Cardiovascular disease Acetylsalicylic acid Review Antiplatelet agent Non steroidal antiinflammatory agent Prevention Analgesic Primary Antipyretic Oxidoreductases Salicylates Elderly
ISSN:	1170-229X, 1179-1969, 1179-1969
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Abstract	The role of aspirin in the secondary prevention of occlusive cardiovascular events has now been well established. Given this, aspirin in primary prevention has been the focus of several large trials and subsequent meta-analyses over the past 3 decades, and yet the issue remains controversial. Recent studies in populations with high baseline risk — such as diabetics and those with asymptomatic peripheral arterial disease — have not found the expected benefits of aspirin on cardiovascular endpoints, which contrasts with earlier studies that reported a reduced relative risk for outcomes such as myocardial infarction and ischaemic stroke, but not for mortality. Furthermore, in healthy populations, the absolute risk reduction conferred by aspirin is small and needs to be balanced against the risk of a major haemorrhage. Older adults have a higher risk for cardiovascular events and therefore might represent the group in which aspirin for primary prevention could deliver the greatest absolute benefit, yet at the same time, the elderly bear an increased vulnerability to major haemorrhage, including haemorrhagic stroke. It is also not known whether older adults experience the same risk reduction from aspirin as middle-aged individuals. The current evidence base does not sufficiently clarify whether aspirin for primary prevention confers a meaningful net benefit in the elderly.
AbstractList	The role of aspirin in the secondary prevention of occlusive cardiovascular events has now been well established. Given this, aspirin in primary prevention has been the focus of several large trials and subsequent meta-analyses over the past 3 decades, and yet the issue remains controversial. Recent studies in populations with high baseline risk - such as diabetics and those with asymptomatic peripheral arterial disease - have not found the expected benefits of aspirin on cardiovascular endpoints, which contrasts with earlier studies that reported a reduced relative risk for outcomes such as myocardial infarction and ischaemic stroke, but not for mortality. Furthermore, in healthy populations, the absolute risk reduction conferred by aspirin is small and needs to be balanced against the risk of a major haemorrhage. Older adults have a higher risk for cardiovascular events and therefore might represent the group in which aspirin for primary prevention could deliver the greatest absolute benefit, yet at the same time, the elderly bear an increased vulnerability to major haemorrhage, including haemorrhagic stroke. It is also not known whether older adults experience the same risk reduction from aspirin as middle-aged individuals. The current evidence base does not sufficiently clarify whether aspirin for primary prevention confers a meaningful net benefit in the elderly.The role of aspirin in the secondary prevention of occlusive cardiovascular events has now been well established. Given this, aspirin in primary prevention has been the focus of several large trials and subsequent meta-analyses over the past 3 decades, and yet the issue remains controversial. Recent studies in populations with high baseline risk - such as diabetics and those with asymptomatic peripheral arterial disease - have not found the expected benefits of aspirin on cardiovascular endpoints, which contrasts with earlier studies that reported a reduced relative risk for outcomes such as myocardial infarction and ischaemic stroke, but not for mortality. Furthermore, in healthy populations, the absolute risk reduction conferred by aspirin is small and needs to be balanced against the risk of a major haemorrhage. Older adults have a higher risk for cardiovascular events and therefore might represent the group in which aspirin for primary prevention could deliver the greatest absolute benefit, yet at the same time, the elderly bear an increased vulnerability to major haemorrhage, including haemorrhagic stroke. It is also not known whether older adults experience the same risk reduction from aspirin as middle-aged individuals. The current evidence base does not sufficiently clarify whether aspirin for primary prevention confers a meaningful net benefit in the elderly. The role of aspirin in the secondary prevention of occlusive cardiovascular events has now been well established. Given this, aspirin in primary prevention has been the focus of several large trials and subsequent meta-analyses over the past 3 decades, and yet the issue remains controversial. Recent studies in populations with high baseline risk — such as diabetics and those with asymptomatic peripheral arterial disease — have not found the expected benefits of aspirin on cardiovascular endpoints, which contrasts with earlier studies that reported a reduced relative risk for outcomes such as myocardial infarction and ischaemic stroke, but not for mortality. Furthermore, in healthy populations, the absolute risk reduction conferred by aspirin is small and needs to be balanced against the risk of a major haemorrhage. Older adults have a higher risk for cardiovascular events and therefore might represent the group in which aspirin for primary prevention could deliver the greatest absolute benefit, yet at the same time, the elderly bear an increased vulnerability to major haemorrhage, including haemorrhagic stroke. It is also not known whether older adults experience the same risk reduction from aspirin as middle-aged individuals. The current evidence base does not sufficiently clarify whether aspirin for primary prevention confers a meaningful net benefit in the elderly.
Author	Ward, Stephanie A. Demos, Lisa Workman, Barbara McNeil, John J.
Author_xml	– sequence: 1 givenname: Stephanie A. surname: Ward fullname: Ward, Stephanie A. email: Stephanie.ward@monash.edu organization: The Kingston Centre, Monash Ageing Research Centre (MONARC), Department of Epidemiology and Preventive Medicine, Monash University, Western Health – sequence: 2 givenname: Lisa surname: Demos fullname: Demos, Lisa organization: Department of Epidemiology and Preventive Medicine, Monash University – sequence: 3 givenname: Barbara surname: Workman fullname: Workman, Barbara organization: The Kingston Centre, Monash Ageing Research Centre (MONARC) – sequence: 4 givenname: John J. surname: McNeil fullname: McNeil, John J. organization: Department of Epidemiology and Preventive Medicine, Monash University
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Keywords	Prasugrel Aspirin Primary Prevention Ischaemic Stroke Ticagrelor Human Prostaglandin-endoperoxide synthase Enzyme Enzyme inhibitor Cardiovascular disease Acetylsalicylic acid Review Antiplatelet agent Non steroidal antiinflammatory agent Prevention Analgesic Primary Antipyretic Oxidoreductases Salicylates Elderly
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Snippet	The role of aspirin in the secondary prevention of occlusive cardiovascular events has now been well established. Given this, aspirin in primary prevention has...
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SubjectTerms	Aged Aspirin - pharmacology Biological and medical sciences Cardiovascular Diseases - prevention & control Current Opinion Geriatrics/Gerontology Humans Internal Medicine Medical sciences Medicine Medicine & Public Health Pharmacology. Drug treatments Pharmacology/Toxicology Pharmacotherapy Practice Guidelines as Topic Randomized Controlled Trials as Topic
Subtitle	Current Status and Future Directions
Title	Aspirin for Primary Prevention of Cardiovascular Events in the Elderly
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