Charles H. Hennekens has published an editorial in the current issue of Nature Reviews/Cardiology titled “Aspirin in Primary Prevention Needs Individual Judgments.”
Hennekens, the first to discover that aspirin prevents a first heart attack and is of lifesaving benefit when given during a heart attack or among long-term survivors, was invited by the editor of the journal to provide perspectives on the recent U.S. Food and Drug Administration (FDA) statements that any decision to use aspirin should be an individual clinical judgment by healthcare providers. The authors provide updates to clinicians and their patients on the optimal use of aspirin for the treatment and prevention of a first heart attack.
“All patients suffering a heart attack or blockage of an artery in the brain should receive 325mg of regular aspirin promptly, and daily aspirin thereafter to reduce their death rate as well as subsequent heart attacks and strokes,” said Hennekens. “Among long-term survivors of prior heart attacks, occlusive strokes or blockages in the arteries of the legs, aspirin should be continued long-term unless there is a specific contraindication.”
In primary prevention, Hennekens and DeMets strongly endorse the recent FDA statement that any judgments about prescribing long-term aspirin for apparently healthy individuals should be based on individual clinical judgments between the healthcare provider and each of his or her patients. This individual clinical judgment should weigh the absolute risk of a first heart attack against the absolute risk of a major bleed.
“The increasing burden of cardiovascular disease in developed and developing countries underscores the need for more-widespread therapeutic lifestyle changes as well as the adjunctive use of drug therapies of proven net benefit in the primary prevention of cardiovascular disease,” said Hennekens. “These should include statins to lower LDL-cholesterol levels, and various drugs necessary to achieve control of high blood pressure.” Hennekens added that “general guidelines for the utilization of aspirin among all apparently healthy adults are not yet justified.”

Source Newsroom: Florida Atlantic University
Citations
Nature Reviews: Cardiology