April 8, 2020
In 2019, the American College of Cardiology/American Heart Association (ACC/AHA) Primary Prevention Guidelines included new recommendations regarding aspirin therapy. The guidelines now advise that daily, low-dose aspirin should be used infrequently to prevent cardiovascular disease in individuals without a prior cardiovascular event.
Aspirin can be hard on the stomach and intestines and can cause ulcers, occasionally leading to serious bleeding. The new guidelines thus recommend that physicians consider low-dose aspirin only for very select high-risk adults ages 40-70 who are at higher risk for atherosclerotic cardiovascular disease (ASCVD), but not at high risk of bleeding. However, the challenge for physicians is finding the best way to identify these specific patients.
Dr. Michael Miedema, director of cardiovascular prevention at MHIF, was a member of the committee that wrote the 2019 guidelines and was recently part of a research team looking at the best method to identify appropriate patients for use of aspirin for primary prevention – meaning individuals without a prior heart attack or stroke. In recently published research in Circulation, the team studied the value of coronary artery calcium (CAC) scoring for guiding aspirin allocation for primary prevention, using a 2019 aspirin meta-analysis data on cardiovascular disease relative risk reduction and bleeding risk. CAC scoring, also called a coronary calcium scan, is a test that measures the amount of calcium in the walls of the heart’s arteries.
The research found that individuals with elevated CAC scores were more likely to avoid a heart attack or stroke with aspirin use than to have it cause a major bleed. Conversely, those with no calcified plaque were unlikely to benefit from the aspirin but still were at risk of bleeding.
“Many patients take a baby aspirin daily ‘just to be safe,’ ” said Dr. Miedema. “What this study shows is that for individuals with zero calcified plaque, taking a daily aspirin is probably not a safe choice at all. It’s really only those with significant plaque who should consider aspirin after discussing it with their provider.”
Committed to Prevention Research
MHIF has a long history of groundbreaking research and education across a wide spectrum of prevention-related topics, including coronary artery calcium testing, blood pressure, cholesterol and statin use, nutrition and lifestyle behaviors, risk factors and screening for specific populations, premature heart disease and genetic disorders. MHIF researchers also led a 10-year transformative population health research project in rural New Ulm, Minnesota, that resulted in significant improvements for cardiovascular disease risk factors in the community. Prevention continues to be a key area of research as part of MHIF’s commitment to creating a world without heart and vascular disease.