The Benefits of Low-Dose Aspirin

Patients with cardiovascular risks can take a proactive approach to their health by starting a low-dose aspirin regimen.

Cardiovascular disease (CVD), a class of diseases that includes myocardial infarction (MI) and stroke, is the leading cause of death among both men and women in the United States. According to the Centers for Disease Control and Prevention (CDC), an individual in the United States experiences a coronary event nearly every 25 seconds; approximately every minute, an individual dies from a coronary event.¹ In 2010, an estimated 785,000 Americans experienced a coronary event, and an estimated 470,000 individuals had a recurring attack.¹

The use of low-dose aspirin continues to be widely recommended by many physicians and is indicated for the prevention of thromboembolic events such as MI and stroke in high-risk patients due to its inhibitory effects on platelet function.^2,3 Studies report that the use of low-dose aspirin has been associated with a decrease in the incidence and risk of death associated with MI, unstable angina, transient ischemic attack, and stroke.⁴

Recommending Low-Dose Aspirin

According to the United States Preventive Services Task Force (USPSTF), aspirin therapy is recommended in men aged 45 to 79 years when the potential benefit of a reduction in MI outweighs the increased risk of gastrointestinal hemorrhage.^5,6 The task force also recommends the use of aspirin in women aged 55 to 79 years when the potential benefit of a reduction in ischemic stroke outweighs the risks.^5,6

In men and women 80 years and older, current evidence is insufficient to assess the balance of benefits and harms of aspirin therapy for the prevention of CVD, according to the USPSTF.^5,6 The panel also advises against the use of aspirin for stroke prevention in women 55 years and younger, and for MI prevention in men 45 years and younger.^5,6 More information about the USPSTF recommendations regarding aspirin therapy can be found at: www.uspreventiveservicestaskforce.org/uspstf09/ aspirincvd/aspcvdrs.htm.

The American Heart Association (AHA) recommends that individuals at high risk of MI take low-dose aspirin daily if advised by their primary health care provider.⁷ In addition, the AHA recommends that heart attack survivors take low-dose aspirin regularly to decrease the risk of or prevent another heart attack.⁷

According to the American Diabetes Association’s (ADA’s) 2011 Standards of Medical Care in Diabetes, aspirin therapy (75-162 mg/day) should be considered as a primary prevention strategy in patients with type 1 or type 2 diabetes who are at increased risk for cardiovascular events (10-year risk >10%).^8,9 This recommendation includes most men 50 years and older, and women 60 years and older who have at least 1 additional major risk factor such as a family history of CVD, hypertension, smoking, dyslipidemia, or albuminuria.^8,9 The 2011 ADA Standards of Care also state that aspirin should not be recommended for CVD prevention for adults with diabetes at low risk for CVD (10-year CVD risk <5%, which includes men <50 and women <60 years of age with no major additional CVD risk factors), because the potential adverse effects from bleeding likely offset the potential benefits.^8,9

Lowering Incidence of CVD

Many efforts have focused on increased awareness regarding the prevention and reduction of CVD. On September 13, 2011, the US Department of Health and Human Services launched the Million Hearts program, a collaborative effort among many nonprofit and private organizations.^10-12 The program is a national initiative designed to prevent 1 million heart attacks and strokes over the next 5 years using strategies that include^10-12:

• Prioritizing the focusing of attention on the ABCS (Aspirin for individuals at high risk, Blood pressure control, Cholesterol management, Smoking cessation)
• Using health information technologies such as electronic health records to more effectively track management of the ABCS and drive improvement
• Creating programs to improve health by increasing physical activity and reducing the prevalence of obesity and diabetes
• Fostering community-based initiatives to promote preventive care
• Establishing benchmarks to measure successes and shortfalls in clinical and community prevention

More information on this program can be found at the Million Hearts Web site (http://millionhearts.hhs.gov).

Counseling Points

Pharmacists are likely to encounter patients seeking guidance in selecting low-dose aspirin products (Table). These products range in strength from 81 to 162 mg and are available in both chewable form and a safetycoated enteric form, such as Ecotrin (GlaxoSmithKline). Some products, including St. Joseph Aspirin, are available in both chewable and enteric-coated formulations. There are also products developed specifically for women, such as Bayer Women’s Low Dose Aspirin, which contains 81 mg of aspirin and a calcium carbonate buffer.

Pharmacists should encourage patients to discuss their cardiovascular risk factors with their primary health care provider. Because the risks and benefits of aspirin therapy vary from individual to individual, all patients should be advised to consult with their primary health care provider before beginning a low-dose aspirin regimen to ascertain the appropriateness of therapy. This is especially important if the patient has other medical conditions and/or is currently taking any other medications, including alternative therapies.

Before recommending any low-dose aspirin therapy product, it is imperative for pharmacists to assess the patient’s allergy history, concurrent medical history, and medication history to screen for potential contraindications and drug interactions.

Individuals with an allergy to aspirin or other salicylates, a history of stomach ulcers and gastrointestinal bleeding, blood clotting disorders, uncontrolled hypertension, or hepatic or renal disease should avoid the use of aspirin and should consult their primary health care provider.^13-15 Patients who consume more than 3 alcoholic drinks per day should avoid aspirin because of the increased risk of gastrointestinal bleeding.^2,13-15

It is important to note that use of aspirin may trigger asthma attacks in certain individuals.^2,13-15 Pharmacists should counsel patients thoroughly about the proper use of aspirin products and inform them of potential adverse effects, and the importance of compliance and routine monitoring by their primary health care provider.

Patients should be reminded to alert health care providers—including their physician, dentist, and pharmacist&mdash;of their aspirin use and to never abruptly stop aspirin therapy without first consulting their physician.

During counseling, pharmacists should also remind patients about the importance of discussing their cardiovascular risks with their primary health care provider and address modifiable risk factors such as being overweight and having a history of tobacco or alcohol use, a diet high in fat and cholesterol, or a sedentary lifestyle.

Patients should be encouraged to take a proactive role in their health to prevent or decrease the risks of CVD. They should be made aware that even small changes can make a difference and that a proactive approach to their health and overall well-being may actually save their lives.

A patient resource entitled “Aspirin for Reducing Your Risk of Heart Attack and Stroke: Know the Facts” can be found on the FDA Web site. PT

Ms. Terrie is a clinical pharmacy writer based in Haymarket, Virginia.

References:

• Kris-Etherton PM, Harris WS, Appel LJ. Fish consumption, fish oil, omega-3 fatty acids, and cardiovascular disease. Circulation. 2002;106:2747-2757.
• McQueen CE, Orr KK. Natural products. In: Berardi R, Ferreri S, Hume A, et al, eds. Handbook of Nonprescription Drugs. Washington, DC: American Pharmacists Association; 2009:975.
• Briggs GC, Hurley H. In: Berardi R, Ferreri S, Hume A, et al, eds. Handbook of Nonprescription Drugs. Washington, DC: American Pharmacists Association; 2009:930-933.