Importance of Low Dose Aspirin in Cardiac Health Essay

This work comprises an annotated bibliography that explores various aspects of aspirin as a primary or secondary treatment for coronary heart diseases. With this respect, the paper combines various journals about aspirin with regard to cardiovascular diseases treatment, assessing the various aspects of the treatment such as cost-effectiveness, when in comparison with clopidogrel.Importance of Low Dose Aspirin in Cardiac Health Essay

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Additionally, the paper illustrates the benefits and the harms that are associated with use of aspirin primarily or secondarily for treatment of cardiovascular diseases. Lastly, the paper compares and contrasts the aspirin therapies on women and men.

Introduction
Aspirin is widely regarded in the treatment of coronary heart diseases. With this regard, aspirin is used both primarily and secondarily as a treatment for coronary heart disease. The effectiveness of aspirin therapies in the prevention or treatment of myocardial infarction or stroke is more observable, when considered secondarily rather than primarily. Aspirin is more cost effective in the treatment of coronary heart diseases that glopidogrel. In line with this regard, users prefer aspirin from a cost effective perspective.Importance of Low Dose Aspirin in Cardiac Health Essay

However, patients who are not eligible for aspirin therapies opt for the glopidogrel therapy. The use of aspirin as a primary therapy for coronary heart diseases has associated costs and benefits. With this regard, the benefits of using aspirin involve reduced chances of contracting cardiovascular diseases such as myocardial infarction and stroke. On the downside, the risk involved is gastrointestinal bleeding.

Berger, J. S., Roncaglioni, M. C., Pangrazzi, I., Tognoni, G., & Brown, D. L. (2006).
Aspirin for the Primary Prevention of Cardiovascular Events in Women and Men: A Sex-Specific Meta-analysis of Randomized Controlled Trials. Jama-journal of The American Medical Association.

The purpose of this study was to determine if the benefits and risks of aspirin therapy to prevent cardiovascular disease vary by sex. The findings of the test showed low dose aspirin therapy could help reduce cardiovascular events in both males and females. It indicated the therapy was useful in lessening the risk of strokes for women and risk of myocardial infarction for men. It is suggestive that fewer women have myocardial infarctions than men, and men have less strokes then women.Importance of Low Dose Aspirin in Cardiac Health Essay

These variables call for further studies even though indications of aspirin therapy prove successful. Additional studies are required before it can be determined if both sexes differ in their cardiovascular response to aspirin. Along with the benefits, there come risks. One major risk associated with taking low dose aspirin is bleeding. In tests it shows that both men and females are at equal risk. Below is an illustration of the risk women are exposed to.

In the primary use of aspirin for primary prevention of cardiovascular disease, the study reveals that a variation of age exist between men and women to whom the medication is recommendable. For men, aspirin is recommended for those aged between45-79 in reduction of the risk of contracting myocardial infarction (MI). On the contrast, the study reveals that women aged 55-79 are recommendable for the aspirin medication to reduce the risk of contacting ischemic stroke.Importance of Low Dose Aspirin in Cardiac Health Essay

Therefore, in prevention of cardiovascular diseases, men stand a higher chance of contracting the diseases at a lower age than women. With this regard, aspirin is recommendable for primary prevention myocardial infarction among men aged 45-79 and prevention of stroke among women aged 55-79. The use of aspirin in cardiovascular disease prevention in men aged below 45 and women aged below 55 is prohibited.

Aspirin use in men
Aspirin use in women

32% relative risk reduction for MI
No effect on stroke or all-cause mortality
17% relative risk reduction for strokes
No effect on MI or all-cause mortality
Source: U.S. Preventive Services Task Force. Aspirin for the Prevention of Cardiovascular Disease: Recommendation Statement. AHRQ Publication No. 09-05129-EF-2, March 2009. Agency for Healthcare Research and Quality, Rockville, MD.http://www.ahrq.gov/clinic/uspstf09/aspirincvd/aspcvdrs.htm.Importance of Low Dose Aspirin in Cardiac Health Essay

Gasparyan, A. Y., Watson, T., & Lip, G. Y. (2008). The Role of Aspirin in Cardiovascular Prevention. Journal of The American College of Cardiology.

The purpose of this study was to discuss a patient’s resistance to long-term aspirin therapy. There are many cardiovascular diseases that are directly affected by thrombus, an anti-platelet agent can aid in lessening the risks a person may have cardiac complications.

The drug is well tolerated by utmost patients, and doesn’t have many risks involved besides bleeding. Since the tests revealed that not many patients have a genuine resistance to the drug, aspirin can continue to prove well in playing a role in long-term cardiovascular disease prevention. Some modifiable and non-modifiable elements can inhibit platelet aggregation, which can limit its affect in cardiovascular disease prevention.Importance of Low Dose Aspirin in Cardiac Health Essay

Additionally, the study reveals that aspirin should be considered for secondary prevention of cardiovascular disease such as MI and stroke. It should be noted that the balance of benefits and risks in the use aspirin primarily for cardiovascular diseases prevention should be carefully considered for different patient. In line with this focus, there is the risk of gastrointestinal bleeding and other risk factors related to cardiovascular diseases. Additionally, it is notable that aspirin therapy is does not work for all patients with cardiovascular diseases. numerous patients are on record for failing to respond to aspirin therapies.Importance of Low Dose Aspirin in Cardiac Health Essay

Often, the failure to respond to aspirin therapy is characterized by thrombotic events despite treatment. With this regard, aspirin fails to inhibit platelet aggregation Further, the study revealed that aspirin therapy can still play a significant role in the primary prevention of vascular diseases, despite exposure to certain risks, such as gastrointestinal bleeding. With this regard, the study notes that aspirin therapy is significant in not only reducing vascular events, but also in linking atherothrombosis and chronic inflammation.Importance of Low Dose Aspirin in Cardiac Health Essay

Additionally, the study reveals that certain markers of the inflammation provided predictive grounds for propensity to contracting MI or stroke in future. Further, the presence of a marker of inflammation, which is basically a C-reactive protein, is a reflection of aspirin use and an indicator of lower risks of contracting MI in men. Notably, studies reveal that aspirin therapies as secondary interventions rather than primary, reveal a greater positive efficacy of aspirin therapy.

Gaspoz, J., Coxson, P. G., Goldman, P. A., Williams, L. W., Kuntz, K. M., Hunink, M. G., & Goldman, L. (2002). Cost Effectiveness of Aspirin, Clopidogrel, or Both for Secondary Prevention of Coronary Heart Disease. New England Journal of Medicine.Importance of Low Dose Aspirin in Cardiac Health Essay

Aspirin therapy has many used for many years, and is found effective in patients that have had previous cardiovascular diseases. Helping reduce the rate of new myocardial infarctions, stroke, or death from vascular causes by nearly 30%. This study was conducted to analyze the long-term use of aspirin, Clopidogrel, or both drugs as a cost effective secondary treatment method for patients with known coronary disease.Importance of Low Dose Aspirin in Cardiac Health Essay

Although the test was done to show the cost effectiveness of the drugs, it illustrates that costs over time would increase because aspirin would prevail to aid in decreasing mortality percentages in patients with coronary disease or the susceptibility to coronary events because of deaths prevented by aspirin therapy. The study supports evidence of the drug assisting both short and long term therapy goals in patients with acute phases of myocardial infarction. There is an optimistic outlook for secondary prevention of coronary disease by use of aspirin. Notably, the both drugs are better used as secondary interventions with cardiovascular diseases rather than primary.Importance of Low Dose Aspirin in Cardiac Health Essay

This study reveals that Clopidogrel is less cost effective than aspirin when used in combined with aspirin. Over a wide range of assumptions from both informed and non informed users, Clopidogrel remains unattractive financially. As a result, patients suffering from cardiovascular diseases opt for aspirin therapy, rather that Clopidogrel or a combination. Due to its cost friendliness, aspirin is widely regarded in primarily and secondarily for treatment of cardiovascular related disease such as MI and stroke.

The study concludes that the use of aspirin for primary or secondary cardiovascular treatment is friendly from an affordability perspective. The use of Clopidogrel therapy involves continuously increasing costs. In line with this regard, Clopidogrel is often associated to patients who are illegible for aspirin.Importance of Low Dose Aspirin in Cardiac Health Essay

Sanmuganathan, P. S., Ghahramani, P., Jackson, P. R., Wallis, E. J., & Ramsay, L. E. (2001). Aspirin for primary prevention of coronary heart disease: safety and absolute benefit related to coronary risk derived from meta-analysis of randomized trials. Heart.

The purpose of this study was to assess the risk thresholds associated with using aspirin for primary prevention of coronary heart disease, and to evaluate if it is safe and worthwhile. Additionally, the study, examines the benefits against the harms associated with aspirin use primarily or secondarily as a treatment for coronary heart disease. The results of the test elucidated that aspirin therapy significantly reduced all cardiovascular events by nearly 15%, myocardial infarctions by 30%, and reduced all deaths by 6%.Importance of Low Dose Aspirin in Cardiac Health Essay

Only significant concern shown in this study was the increased risk of major bleeding. This risk is balanced by the reduction in cardiovascular events. Study concluded that aspirin therapy for primary prevention is safe and worthwhile. When it comes to cardiovascular event risk, aspirin has exhibited that it is a great alternative for primary prevention, doing more good than harm.

The outcome of the study reveals that the benefit derived from the use of aspirin in treatment of coronary diseases is the significant reduction of cardiovascular events such as strokes in women, myocardial infractions in men and general increase in mortality rate. On the other hand, the study reveals that the harm associated with use of aspirin in treatment of coronary heart diseases involves hemorrhages and significant bleeding known as gastrointestinal bleeding. In conclusion, there is a degree of safety in the primary use of aspirin in prevention of coronary heart diseases. The benefits derived include significantly lowered risk of contracting myocardial infarction or stroke with respect to gender and age. In line with this focus, formal accurate estimation with regard to absolute coronary event risk is very vital, when giving advice on the use of aspirin for primary prevention of coronary heart diseases.Importance of Low Dose Aspirin in Cardiac Health Essay

Gasparyan, A. Y., Watson, T., & Lip, G. Y. (2008). The role of aspirin in cardiovascular prevention: implications of aspirin resistance. Journal of the American College of Cardiology, 51(19), 1829-1843.

The administration of aspirin secondarily or primarily depends on whether the patient is eligible for aspirin therapy in the prevention of cardiovascular diseases. This study notes that some patients are not eligible for aspirin therapy. On such an occasion, the administration of aspirin medication on such patients may have detrimental health implications on the patient. With this regard, the patients develop a bleeding condition known as gastrointestinal bleeding. However, such patients may be put under Clopidogrel medication.Importance of Low Dose Aspirin in Cardiac Health Essay

Hayden, M., Pignone, M., Phillips, C., & Mulrow, C. (2002). Aspirin for the primary prevention of cardiovascular events: a summary of the evidence for the US Preventive Services Task Force. Annals of Internal Medicine, 136(2), 161-172.

This study illustrates the effectiveness and implications of use of aspirin in primary prevention of cardiovascular diseases. Additionally the study notes that aspirin therapy entails various benefits and risks, when applied primarily for prevention of cardiovascular diseases. The benefits drawn from primary use of aspirin therapy for cardiovascular diseases prevention include lowering of the risk of contracting myocardial infarction and stroke.Importance of Low Dose Aspirin in Cardiac Health Essay

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The drug is well tolerated by utmost patients, and doesn’t have many risks involved besides bleeding. Since the tests revealed that not many patients have a genuine resistance to the drug, aspirin can continue to prove well in playing a role in long-term cardiovascular disease prevention. Some modifiable and non-modifiable elements can inhibit platelet aggregation, which can limit its affect in cardiovascular disease prevention.

Low-dose aspirin has been shown to be effective in preventing about one-fifth of atherothrombotic vascular complications (non-fatal myocardial infarction, non-fatal stroke, or vascular death) in a meta-analysis of 16 secondary prevention trials in patients with previous myocardial infarction, stroke, or transient cerebral ischaemia.1 This corresponds to an absolute reduction of about 10–20 per 1000 patients in the yearly incidence of non-fatal events, and to a smaller, but still definite, reduction in vascular death.1 Against this benefit, the absolute increase in major extracranial bleeding complications [mostly, gastrointestinal (GI)] is 20- to 50-fold smaller, depending on age and sex.1 Hence, for secondary prevention, the benefits of antiplatelet therapy substantially exceed the risks. Whether this favourable benefit/risk ratio extends beyond the 2–3 year duration of randomized treatment has not been formally tested. However, in patients prescribed with low-dose aspirin for the secondary prevention of cardiovascular or cerebrovascular events, discontinuation of antiplatelet therapy was associated with a 40% increase in the relative risk of ischaemic stroke2 and myocardial infarction3 compared with continuation of therapy.Importance of Low Dose Aspirin in Cardiac Health Essay

For primary prevention, the balance between vascular events avoided and major bleeds caused by aspirin is substantially uncertain because the risks without aspirin, and hence the absolute benefits of antiplatelet prophylaxis, are at least an order of magnitude lower than in secondary prevention.1 The aim of this article is to review the updated evidence for the efficacy and safety of low-dose aspirin in primary prevention and to discuss additional health benefits resulting from prolonged antiplatelet therapy in apparently healthy people at low average risk of vascular events.Importance of Low Dose Aspirin in Cardiac Health Essay

Some mechanistic considerations to interpret clinical trial results
Before discussing the results of aspirin trials in primary prevention, it seems appropriate to review briefly the unique features of aspirin’s pharmacokinetics (PK) and pharmacodynamics (PD) in inhibiting platelet function.4,5 The drug permanently inactivates the cyclooxygenase (COX) activity of the platelet enzyme, prostaglandin (PG)G/H-synthase-1 (also referred to colloquially as COX-1), responsible for the first committed step in prostanoid biosynthesis. In human platelets, this results in dose- and time-dependent inhibition of thromboxane (TX)A2 formation. Platelet TXA2 production represents an important amplification mechanism of platelet activation, by virtue of its being triggered in response to any platelet agonist and in turn inducing further platelet recruitment and aggregation.Importance of Low Dose Aspirin in Cardiac Health Essay 6 In healthy subjects, inhibition of platelet TXA2 production by aspirin is cumulative upon repeated daily dosing and saturable at low doses (≥30 mg) because of its irreversible nature.7 In contrast to the uniform effectiveness of low-dose aspirin in blocking platelet COX-1 activity in healthy individuals,8 some clinical conditions are associated with suboptimal antiplatelet effects of aspirin. These include patients following coronary artery bypass surgery,9 patients with essential thrombocythaemia,10 patients with coronary artery disease who have metabolic syndrome (independently of diabetes mellitus),11 and type 2 diabetes mellitus.12 The mechanisms of suboptimal aspirin effect in these conditions are likely related to the fact that they all are associated with increased in vivo platelet activation.6 Thus, impaired acetylation of platelet COX-1 could result from accelerated platelet turnover,10 or from platelet activation-induced generation of hydroperoxides that are known to impair the acetylation of COX-isozymes by aspirin.13 Given the short half-life (∼20 min) of aspirin in the human circulation, the long-lasting duration of its antiplatelet effect is ensured by acetylation of COX-1 in bone-marrow megakaryocytes and limited de novo protein synthesis in blood platelets.4,5 These factors typically allow a once daily regimen of aspirin administration, when the drug is used as an antiplatelet agent. However, changes in the systemic bioavailability of the drug, as may occur with some enteric-coated formulations and in association with obesity,14 or faster renewal of the drug target, as may occur in association with altered megakaryopoiesis,15 may limit the duration of its antiplatelet effect and require a different (e.g. bid) dosing regimen.Importance of Low Dose Aspirin in Cardiac Health Essay

As detailed in Table 1, the aspirin regimen in six of the nine primary prevention trials was a once daily regimen of 75 or 100 mg aspirin in enteric-coated or controlled-release formulations;17–22 one trial used a daily regimen of 500 mg;23 and two US studies24,25 opted for alternate-day regimens of 100 or 325 mg. Rocca et al.16 have recently described substantial interindividual variability in the recovery rate of platelet COX-1 activity during the 24 h dosing interval, in both diabetic and non-diabetic patients treated with enteric-coated 100 mg aspirin. When contrasting the effects of aspirin in primary vs. secondary prevention, it should be considered that the vast majority of secondary prevention trials utilized plain aspirin tablets, and about 70% of participants allocated to active treatment in these trials were randomized to bid, tid, or qid regimens of aspirin administration.1 A variable combination of these factors may have contributed to small differences in the effect size of aspirin in primary vs. secondary prevention trials,1 and explain the largely inconclusive findings of the most recent primary prevention trials.20–22 The PK/PD rationale of a 48 h dosing interval of aspirin administration in two primary prevention studies24,25 has never been convincingly articulated. One should therefore entertain the possibility that inadequate platelet inhibition during the second half of the dosing interval may have reduced the effect size of the benefit of antiplatelet prophylaxis and the statistical power of the Physicians’ Health Study (PHS)24 and the Women’s Health Study (WHS)25 to demonstrate a significant reduction in their respective primary endpoints. Importance of Low Dose Aspirin in Cardiac Health Essay