Individualize Treatment With Aspirin for Primary Prevention
Authors: John B. Kostis
Journal: Annals of Internal Medicine (2019)

Editorials15 October 2019Individualize Treatment With Aspirin for Primary PreventionJohn B. Kostis, MDJohn B. Kostis, MDCardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey (J.B.K.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M19-2475 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Since the Sumerians used the bark of the willow tree as an analgesic and antipyretic more than 35 centuries ago, humans have used aspirin and its analogues (1). In 1897, Felix Hoffmann synthesized aspirin when he acetylated sodium salicylate, possibly because his father could not tolerate high doses of sodium salicylate, which he took for rheumatism. Nobel Prize winner John Vane first described aspirin's mechanism of action. He proved that aspirin inhibits cyclooxygenase, the enzyme that facilitates the production of prostaglandins, which are responsible for inflammation and fever but have a protective effect on the stomach and kidneys (2).In ...References1. Montinari MR, Minelli S, De Caterina R. The first 3500 years of aspirin history from its roots - a concise summary. Vascul Pharmacol. 2019;113:1-8. [PMID: 30391545] doi:10.1016/j.vph.2018.10.008 CrossrefMedlineGoogle Scholar2. Vane JR, Botting RM. The mechanism of action of aspirin. Thromb Res. 2003;110:255-8. [PMID: 14592543] CrossrefMedlineGoogle Scholar3. Selak V, Jackson R, Poppe K, et al. Personalized prediction of cardiovascular benefits and bleeding harms from aspirin for primary prevention. A benefit–harm analysis. Ann Intern Med. 2019;171:529-39. doi:10.7326/M19-1132 LinkGoogle Scholar4. Pylypchuk R, Wells S, Kerr A, et al. Cardiovascular disease risk prediction equations in 400 000 primary care patients in New Zealand: a derivation and validation study. Lancet. 2018;391:1897-1907. [PMID: 29735391] doi:10.1016/S0140-6736(18)30664-0 CrossrefMedlineGoogle Scholar5. Wells S, Riddell T, Kerr A, et al. Cohort profile: the PREDICT cardiovascular disease cohort in New Zealand primary care (PREDICT-CVD 19). Int J Epidemiol. 2017;46:22. [PMID: 26686841] doi:10.1093/ije/dyv312 CrossrefMedlineGoogle Scholar6. Lacaze P, Woods R, Zoungas S, et al; ASPREE Investigator Group. The genomic potential of the Aspirin in Reducing Events in the Elderly and Statins in Reducing Events in the Elderly studies. Intern Med J. 2017;47:461-463. [PMID: 28401726] doi:10.1111/imj.13384 CrossrefMedlineGoogle Scholar7. Mahmoud AN, Gad MM, Elgendy AY, et al. Efficacy and safety of aspirin for primary prevention of cardiovascular events: a meta-analysis and trial sequential analysis of randomized controlled trials. Eur Heart J. 2019;40:607-617. [PMID: 30561620] doi:10.1093/eurheartj/ehy813 CrossrefMedlineGoogle Scholar8. Sundström J, Hedberg J, Thuresson M, et al. Low-dose aspirin discontinuation and risk of cardiovascular events: a Swedish nationwide, population-based cohort study. Circulation. 2017;136:1183-1192. [PMID: 28947478] doi:10.1161/CIRCULATIONAHA.117.028321 CrossrefMedlineGoogle Scholar9. Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease. Circulation. 2019:CIR0000000000000678. [PMID: 30879355] doi:10.1161/CIR.0000000000000678 CrossrefMedlineGoogle Scholar10. U.S. Food and Drug Administration. Use of aspirin for primary prevention of heart attack and stroke. 2 May 2014. Accessed at www.fda.gov/Drugs/ResourcesForYou/Consumers/ucm390574.htm on 1 August 2019. Google Scholar Author, Article, and Disclosure InformationAffiliations: Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey (J.B.K.)Disclosures: Author has disclosed no conflicts of interest. Form can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-2475.Corresponding Author: John B. Kostis, MD, Cardiovascular Institute, Rutgers Robert Wood Johnson Medical School, 125 Paterson Street, CAB-4180A, New Brunswick, NJ 08901; e-mail, [email protected]rutgers.edu.This article was published at Annals.org on 17 September 2019. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoPersonalized Prediction of Cardiovascular Benefits and Bleeding Harms From Aspirin for Primary Prevention Vanessa Selak , Rod Jackson , Katrina Poppe , Billy Wu , Matire Harwood , Corina Grey , Romana Pylypchuk , Suneela Mehta , Yeun-Hyang Choi , Andrew Kerr , and Sue Wells Metrics 15 October 2019Volume 171, Issue 8Page: 583-584KeywordsAspirinCardiovascular diseasesElderlyHemorrhageRandomized trialsRisk managementSalicylatesSodiumStomachStroke ePublished: 17 September 2019 Issue Published: 15 October 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...