The recommendations of learned societies are contradictory. Should aspirin be used or not as part of a risk prevention strategy for cardiovascular events? A recently published European study shows that the benefit-risk balance needs to be reconsidered.
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Known to relieve pains, fever and rheumatism, the’aspirin – Where acid acetylsalicylic – is a drug widely prescribed in France (with 1,500 tons consumed each year). Beyond its analgesic properties, aspirin has characteristics that block the formation of clots and, as such, is recommended as part of the prevention primary (reduction in the appearance of new cases) and secondary (in order to avoid the progression of the disease) of cardiovascular events in populations at risk (see the good practice recommendations of the High Authority of Health).
What are the effects of aspirin?
THE’aspirin belongs to the group of anti-inflammatory non-steroidal drugs (NSAIDs). It inhibits the synthesis of enzymes allowing the production of prostaglandins : cytokines involved in inflammatory reaction processes. It also inhibits platelet aggregation by blocking the formation of thromboxane (vasoconstrictor and responsible for thrombus formation). It is this last point that makes it attractive in matter cardiovascular prevention. However, it presents significant side effects and can generate complications. hemorrhagic intra or extra-cranial and various digestive disorders.
Conflicting recommendations
Although it is well established that aspirin has benefits for patients who have had previous cardiovascular illnesses, the advantages of its use in primary prevention are increasingly discussed. In October 2021, a group of American experts spoke out against its use in people over 60 years of age because of the risk of bleeding. In addition, the contradictory positions of the international scientific community generate a uncertainty.
A study recently published in a journal of the European Society of Cardiology sheds additional light. Researchers are evaluating the role of aspirin use onimpact cardiac events in patients at risk. Using the database Homage (i.e. 45,000 participants), the scientists included nearly 31,000 people at risk (tobacco, obesity, hypercholesterolemia, hypertension, diabetes). Each person was listed as a user or non-user of aspirin. Monitoring carried out on a duration age group showed that taking aspirin was associated with an increased risk (26%) of new diagnostic ofheart failure in aspirin users.
The large sample size and the duration of the follow-up made it possible to carry out an in-depth investigation into the relevance of the use of aspirin in primary and secondary prevention for patients at risk. This analysis shows that there is an increased risk ofheart failure in patients receiving aspirin with or without a history of cardiovascular illnesses. The authors stress, however, that further studies are still needed to clarify this ambiguous point. However, there are difficulties in interpreting the recommendations, while clinical practice allows for a personalized approach in line with the profile of each patient.
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