The Appropriateness of Aspirin Use for Primary Prevention of Atherosclerotic Disease: A Subgroup Analysis of the ASSOS Study

Year 2021, Volume: 8 Issue: 1, 43 - 46, 30.04.2021

Oguzhan Celık Cem Çil

https://doi.org/10.47572/muskutd.857550

Cited By: 1

Abstract

Aspirin is one of the most commonly used drugs to prevent cardiovascular diseases in our country. However, whether aspirin is used in primary prevention within the appropriate indication has not been adequately studied. The aim of this study is to investigate prescription distribution and appropriate use of aspirin in primary prevention according to international guidelines. The Appropriateness of Aspirin Use in Medical Outpatients: A Multicenter, Observational Study is from all regions of Turkey and provided data from 14 different cities in 30 different cardiology clinics. It has been designed as a multicenter, cross-sectional study. Patients over the age of 18, who applied to the cardiology outpatient clinic, and who regularly use low-dose aspirin (75-100 mg) in the last 30 days for any reason, were included in the study. Patients, who use aspirin for secondary prevention, were excluded for this analysis and the appropriateness of aspirin use was evaluated according to the 2016 European Society of Cardiology (ESC) and 2019 American College of Cardiology/American Heart Association (ACC/AHA) guidelines. Inappropriate aspirin use for primary prevention was detected in 100% of patients according to the 2016 ESC guidelines and in 89% of patients according to the 2019 ACC/AHA guidelines. In our country, inappropriate aspirin use is common in primary prevention according to the ESC guidelines and ACC/AHA guidelines.

Keywords

Aspirin, Compliance with the Guidelines, Primary Prevention

Aterosklerotik Hastalığın Primer Korumasında Aspirin Kullanımının Uygunluğu: ASSOS Çalışmasının Altgrup Analizi

Abstract

Ülkemizde aspirin kardiyovasküler hastalıklardan korunma amacıyla en çok kullanılan ilaçlardan biridir. Ancak aspirinin primer korumada uygun endikasyon dahilinde kullanılıp kullanılmadığı yeterince araştırılmamıştır. Bu çalışmanın amacı, primer korumada aspirinin reçete dağılımını incelemek ve uluslararası kılavuzlara göre uygunluğunu araştırmaktır. The Appropriateness of Aspirin Use in Medical Outpatients: A Multicenter, Observational Study (ASSOS çalışması) Türkiye’nin her bölgesinden ve 14 farklı şehirden 30 farklı kardiyoloji polikliniğinden alınan veriler ile sağlanan çok merkezli kesitsel bir çalışma şeklinde dizayn edilmiştir. Çalışmaya kardiyoloji polikliniğe başvuran 18 yaş üstü, son 30 gün içinde her ne sebeple olursa olsun düzenli olarak düşük doz aspirin (75-100 mg) kullanan hastalar dahil edilmiştir. Çalışmamızda bu hastalardan sekonder koruma nedeniyle aspirin kullananlar çıkarılarak sadece primer koruma amaçlı aspirin kullanananlar değerlendirildi ve sonuçların primer korumada aspirin kullanımının 2016 European Society of Cardiology (ESC) ve 2019 American College of Cardiology/American Heart Association (ACC/AHA) kılavuzlarına göre uygunluk oranı araştırılmıştır. 2016 ESC kılavuzuna göre hastaların %100'ünde, 2019 ACC/AHA kılavuzuna göre ise hastaların %89'unda primer koruma için uygunsuz aspirin kullanımı tespit edildi. Ülkemizde gerek ESC kılavuzuna göre gerekse de ACC/AHA kılavuzuna göre primer korumada uygunsuz aspirin kullanımı sıktır.

Keywords

Aspirin, Kılavuzlara Uygunluk, Primer Koruma

References

• 1. Benjamin EJ, Muntner P, Alonso A, et al. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation. 2019;139:56–528.
• 2. 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.
• 3. Berger JS, Brawn DL, Becker RC. Low-dose aspirin in patients with stable cardiovascular disease: a meta-analysis. Am J Med. 2008;121(1):43–9.
• 4. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts)Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J. 2016;37:2315–81.
• 5. Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;140:596–646.
• 6. WHO Progress in the rational use of medicines. World Health Assembly Resolution, WHA60.16, World Health Organisation, Geneva (2007). http://apps.who.int/gb/ebwha/pdf_files/whassa_wha60- rec1/e/reso-60-en.pdf p.71.
• 7. Çelik O, Çil C, Özlek Ö, et al. Design and rationale for the ASSOS study: Appropriateness of aspirin use in medical outpatients a multicenter and observational study. Anatol J Cardiol. 2018;20(6):354-62.
• 8. Shah RR, Pillai A, Omar A, et al. Utility of the HAS-BLED Score in Risk Stratifying Patients on Dual Antiplatelet Therapy Post 12 Months After Drug-Eluting Stent Placement. Catheter Cardiovasc Interv. 2017;89:99-103.
• 9. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(2):49-73.
• 10. Antithrombotic Trialists’ Collaboration. Collaborative metaanalysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ. 2002;324(7329):71-86.
• 11. Seshasai SR, Wijesuriya S, Sivakumaran R, et al. Effect of aspirin on vascular and nonvascular outcomes: meta-analysis of randomized controlled trials. Arch Intern Med. 2012;172:209-16.
• 12. Naderi SH, Bestwick JP, Wald DS. Adherence to drugs that prevent cardiovascular disease: a meta-analysis on 376,162 patients. Am J Med. 2012;125:882-7.
• 13. VanWormer JJ, Greenlee RT, McBride PE, et al. Aspirin for primary prevention of CVD: are the right people using it? J Fam Pract. 2012;61:525-32.
• 14. U.S. Preventive Services Task Force. Aspirin use for the primary prevention of cardiovascular disease and colorectal cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2016;164:836-45.
• 15. The Task Force on diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and developed in collaboration with the European Association for the Study of Diabetes (EASD). Eur Heart J. 2013;34:3035-87.
• 16. American Heart Association Diabetes Committee of the Council on Lifestyle and Cardiometabolic Health, Council on Clinical Cardiology, Council on Cardiovascular and Stroke Nursing, Council on Cardiovascular Surgery and Anesthesia, Council on Quality of Care and Outcomes Research, and the American Diabetes Association Update on Prevention of Cardiovascular Disease in Adults With Type 2 Diabetes Mellitus in Light of Recent Evidence: A Scientific Statement From the American Heart Association and the American Diabetes Association. Circulation. 2015;132:691-718.