Open AccessAspirin in chronic cardiovascular disease and acute myocardial infarction
Author(s) -
Hennekens C. H.
Publication year - 1990
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.4960131314
Subject(s) - aspirin , medicine , myocardial infarction , stroke (engine) , unstable angina , cardiology , placebo , angina , vascular disease , pathology , mechanical engineering , alternative medicine , engineering
The ability of low‐dose aspirin to irreversibly inhibit platelet‐dependent cyclooxygenase provides a biologic mechanism to explain why this drug may decrease the risk of thrombotic cardiovascular events. Observational epidemiologic studies, both case‐control and cohort, have suggested that aspirin might reduce the risk of cardiovascular disease by approximately 20 to 30%. An overview of 25 randomized trials of aspirin among individuals with a history of prior cardiovascular disease demonstrated that those receiving aspirin experienced a significant 25% reduction in the occurrence of “important vascular events,” an endpoint that combines nonfatal myocardial infarction (MI), nonfatal stroke, and cardiovascular death. There were also significant 32% reductions in subsequent nonfatal MI, 27% reductions in nonfatal stroke, and 15% reductions in vascular mortality. Thus, individuals with a history of MI, stroke, transient ischemic attack, or unstable angina clearly benefit from aspirin. The Second International Study of Infarct Survival (ISIS‐2) sought to determine if benefits would accrue if aspirin was given within the first 24 hours of suspected evolving MI. The aspirin group experienced a significant 23 % reduction in 5‐week vascular mortality compared with those receiving placebo. Aspirin was also associated with significantly fewer reinfarctions and strokes. Thus, among those with suspected evolving MI, aspirin significantly reduces the risk of reinfarction, stroke, and vascular mortality. These analyses indicate that aspirin is of proven value in the therapy of most patients who have survived MI, stroke, or unstable angina, as well as those evolving a suspected MI. Low‐dose aspirin therapy, in general, should be prescribed by a physician or other health care provider, taking into account the cardiovascular risk profile of the patient, the side effects of aspirin, and these demonstrated benefits in reducing various manifestations of cardiovascular disease. Aspirin should be viewed as an adjunct, not alternative, to reduction of the major risk factors of elevated cholesterol, cigarette smoking, and hypertension.