The need for wider and appropriate utilization of aspirin and statins in the treatment and prevention of cardiovascular disease

Abstract

There is an increasing burden of occlusive cardiovascular disease (CVD) in developed, as well as in developing, countries. In fact, the WHO has projected that CVD will become the leading cause of death in the world in the next 10 years. The proximate cause of virtually all occlusive vascular events is thrombosis and the principal underlying cause is atherosclerosis. Aspirin, which inhibits platelet-dependent cyclooxygenase for the entire life of the platelet, has clinically important antithrombotic effects. Statins, which principally decrease low-density lipoprotein cholesterol, triglycerides and increase high-density lipoprotein cholesterol, have clinically important antiatherogenic effects. In secondary prevention, in a wide range of patients who have survived a prior myocardial infarction (MI), occlusive stroke, transient ischemic attack, as well as other high-risk conditions, long-term use of aspirin confers statistically significant and clinically important reductions in MI, stroke and CVD death. In addition, aspirin confers similar benefits when administered during acute MI or acute occlusive stroke. In primary prevention, aspirin confers a statistically significant and clinically important reduction in risk of a first MI but the data on stroke and CVD death remain inconclusive, so aspirin should be prescribed on an individual basis by the healthcare provider who weighs this clear benefit against long-term side effects. In a meta-analysis of 14 randomized trials of 90,056 subjects treated for 5 years, statins confer statistically significant and clinically important reductions in MI, stroke, CVD death and total mortality. In a meta-analysis of randomized trials of statins, in which aspirin was used in varying frequencies, the combination of aspirin and statins conferred greater clinical benefits than either agent alone on MI, occlusive stroke and CVD death. At present, the wider and more appropriate use of aspirin and statins will reduce premature MI, stroke and CVD death.

Keywords::

• aspirin
• atherosclerosis
• cardiovascular disease
• cholesterol
• myocardial infarction
• statins
• stroke

Financial & competing interests disclosure

Dr Hennekens is funded by the Department of Biomedical Science and Center of Excellence at Florida Atlantic University (FAU) as Principal Investigator on two investigator-initiated research grants funded to FAU by Bayer testing the effects of aspirin dose on platelet biomarkers, inflammatory markers, nitric oxide formation and endothelial function. Dr Hennekens serves as consultant, including as Chair or Member on Data and Safety Monitoring Boards, for Actelion, Amgen, AstraZeneca, Bayer, Biovail, Bristol-Myers Squibb, Chattem, Delaco, US FDA, GlaxoSmithKline, Keryx, McNeil, Merck, National Association for Continuing Education, National Institutes of Health, Novartis, Pfizer, PriMed, Reliant, Solvay, TAP, United BioSource Corporation, UpToDate and Wyeth.

Dr Hennekens serves on speakers bureaus for the International Atherosclerosis Society, AstraZeneca concerning lipids and heart failure, as well as Bristol-Myers Squibb, Reliant and Pfizer concerning lipids.

Dr Hennekens receives royalties for authorship or editorship of three textbooks and as co-inventor on patents concerning inflammatory markers and cardiovascular disease which are held by Brigham and Women’s Hospital.

Dr Hennekens has an investment management relationship with SunTrust Bank who has sole discretionary investment authority.

Ms Schneider is funded by the Department of Biomedical Science and Center of Excellence at FAU as Project Coordinator on two investigator-initiated research grants funded to FAU by Bayer testing the effects of aspirin dose on platelet biomarkers, inflammatory markers, nitric oxide formation and endothelial function. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.