Prevention Matters

A new study printed in Current Medical Research and Opinion found that aspirin use for primary prevention of cardiovascular disease (CVD) could produce overall savings of $79.6 million dollars over 10 years for a base population of 1 million patients, while use for secondary prevention shows a savings of $32.2 million. Aspirin use for primary prevention was also shown to save $29 million in out of pocket costs, which is an immediate benefit for patients.

The study measured cost savings associated with aspirin use for the prevention of CVD. Savings are seen if this preventive service was increased to reflect current guidelines with the greatest savings for primary prevention (i.e. in those patients without CVD, but at risk). Current clinical guidelines recommend aspirin use for the primary prevention of heart disease in men and stroke in women.

In addition to producing millions of dollars in savings, the study reported that aspirin use for primary prevention of CVD would prevent 1273 heart attacks, 2184 angina events, and 565 ischemic strokes in a base population of 1 million patients. Aspirin use for the primary prevention of CVD is not just financially valuable – it saves lives.

Partnership for Prevention supports aspirin use for the primary prevention of heart disease and stroke. Partnership convenes the Aspirin Task Force (ATF), a multidisciplinary group of experts committed to promoting aspirin use for the primary prevention of cardiovascular disease. The ATF supports the USPSTF recommendations, and encourages men and women to speak to their health care provider to decide if aspirin use is right for them.

In addition to the aspirin initiative, Partnership’s National Commission on Prevention Priorities (NCPP) has identified aspirin use for primary prevention as one of the highest value clinical preventive services. In fact, the NCPP reports that if 90% of those who were recommendation to use aspirin did use aspirin, 45,000 lives per year would be saved.

This study, along with Partnership’s initiatives, shows the importance of aspirin use for the primary prevention of heart disease and stroke. In particular, the study reinforces the value of utilizing preventive services to benefit our healthcare system and society as a whole.

Robert J. Gould, PhD, President and CEO and Jason M.M. Spangler, MD, MPH, Senior Program Officer were interviewed this morning by Dr. Nieca Goldberg, a cardiologist and women's health expert at NYU Medical Center, on her radio show, "Doctor Radio", carried by Sirius XM Radio. The broadcast garnered interest from the public, as several people called/emailed in with specific screening questions.

In addition to fielding questions, Dr. Gould and Dr. Spangler discussed Partnership’s mission and stressed the importance of prevention. Dr. Gould and Dr. Spangler highlighted the critical work Partnership is accomplishing in the areas of tobacco cessation and control, vaccines, and aspirin use. Dr. Goldberg is a member of Partnership’s Aspirin Task Force, an advisory group tasked with increasing aspirin counseling and aspirin use for primary prevention of cardiovascular disease.

Dr. Gould and Dr. Spangler also touched on the new regulations that require insurance plans to provide United States Preventive Services Task Force (USPSTF) A and B recommended preventive services without cost sharing. These regulations will begin to remove barriers to access to preventive care.

The interview will be re-broadcast today at 5 pm Eastern, Friday July 16 at 5 am Eastern and Sunday July 18 at 5 am Eastern on Sirius channel 114 and XM channel 119.

If you don't have a Sirius or XM subscription, you can sign up for a 7-day free trial period by visiting this website: www.sirius.com/freetrial/register. We hope you will tune in.

Earlier this week, the research article, “Aspirin for Prevention of Cardiovascular Events in a General Population Screened for a Low Ankle Brachial Index (ABI)”, was published in JAMA. The goal of the study was to determine if daily aspirin reduced the risk of heart attack and stroke in patients with a low ABI, a quick and inexpensive way to establish risk for these events, and no other risk factors. Researchers hoped to show that the ABI could identify asymptomatic higher risk individuals that could benefit from preventive treatments, such as aspirin use.

The researchers found that aspirin was not effective in preventing first heart attack, stroke, or other cardiovascular events for individuals with low ABI and an absence of other risk factors. However, due to the fact that ABI was the only indicator used when determining risk, the study population was ultimately found to be at very low risk for heart attack and stroke. According to current guidelines, this low risk group would not be encouraged to use aspirin. So the study may actually say more about ABI or the range of ABI as a screening tool for cardiovascular risk than aspirin for primary prevention of cardiovascular events.

Other issues with the study include adherence to the therapy and disproportionate number of females in the study. Interestingly, the study showed no statistically significant difference between the aspirin and control groups for bleeding. Recently, aspirin use for primary prevention has been questioned due to a potential increased risk for gastrointestinal and intracranial bleeding; this study shows that bleeding events were similar between aspirin and non-aspirin users.

Ultimately, this study shows that ABI or the ABI threshold measurement used (0.95) is not enough to predict higher risk of heart attack and stroke on a population level. Future studies with more participants, improved compliance rates, a more equitable distribution of males and females, and a lower level of ABI for study inclusion are necessary to shed more light on this issue. An editorial, also published in JAMA, further explains the potential limitations of the study. Although at first glance this article appears to be another critique on aspirin for primary prevention-as many media outlets suggested- the current American Heart Association and United States Preventive Services Task Force guidelines for aspirin use to prevent first heart attacks and strokes should still be followed. And, as they recommend, those considering aspirin should talk to their health care provider to determine if aspirin is right for them.

Posted by:
Rebecca Doigan
Program Associate, Partnership for Prevention

Recently, the Wall Street Journal (WSJ) posted an article, “The Danger of Daily Aspirin,” that questioned the use of aspirin for prevention of cardiovascular disease and stroke, citing the increased risk for gastrointestinal (GI) bleeding. Although the WSJ article is generally balanced in its discussion about aspirin use, the headline and some comments from the piece add to the confusion about the appropriate use of aspirin for primary prevention.

The WSJ article references a meta-analysis published in The Lancet in May 2009 as evidence for its arguments regarding caution when taking aspirin for primary prevention of heart disease and stroke. But the story really begins in April 2009 when the U.S. Preventive Services Task Force (USPSTF) – the quasi-governmental body that rigorously evaluates the effectiveness of clinical preventive services – reported that regular aspirin use can reduce first heart attacks in men and first strokes in women. The findings from the USPSTF apply to men 45 and 79 years of age and to women 55 to 79. The USPSTF found that aspirin should be used when the benefits outweigh the harms for potential GI bleeding. This straightforward recommendation helped resolve the often confusing messages consumers receive about aspirin use.

Or so it appeared. Little more than a month later, The Lancet study offered a seemingly conflicting conclusion, namely, that the long-term use of aspirin in preventing first heart attacks and strokes is of uncertain net benefit since the potential benefits and harms may cancel each other out.

The study from the USPSTF and the study appearing in The Lancet relied on the same meta-analyses in their research but still came to different conclusions. How could this happen? In layman’s terms, the reason for the seemingly conflicting conclusions appears to be that the authors of the second study gave equal weight to incidents of GI bleeding as to heart attacks and strokes. In contrast, the USPSTF appears to conclude that it is more important to prevent heart attacks and strokes than to prevent gastrointestinal bleeding events.

Upon closer examination, though, the findings of the two studies are far more similar than they appear. Both the USPSTF and the authors of The Lancet study underscore the importance of patients and healthcare providers discussing the benefits and harms of regular aspirin use.

Partnership for Prevention’s Aspirin Task Force – an independent panel made up of some of the nation’s leading experts on aspirin use – carefully reviewed the methodology, findings, and conclusions of this study. The Aspirin Task Force recommended no immediate change in the use of aspirin and aspirin counseling. Its assessment of The Lancet study can be found here.

The decision to take aspirin can sometimes be difficult. It does have a proven track record in preventing first heart attacks and strokes in men and women, respectively, but, like all medications it does have risks. Therefore, as reiterated by the Aspirin Task Force, the key step in the decision-making process is an informed discussion between patients and their healthcare providers to ensure the appropriate use of aspirin. That is not confusing at all.

Rebecca Doigan
Research Fellow and Program Associate
Partnership for Prevention

New research suggests that regular aspirin use among breast cancer patients may cut the risk of dying by 50 percent.  The Nurses’ Health Study surveyed 4,000 registered nurses and showed that taking aspirin two to five days a week cut the risk of dying by 71 percent, and reduced the risk of cancer spread by 60 percent.

Survey results were published in the Feb. 16 online edition of the Journal of Clinical Oncology.Researchers suspect that aspirin controls breast cancer by reducing inflammation in the body. However, the authors of the study call for more research to confirm the findings before aspirin is recommended for breast cancer alone.

At present, most women take aspirin for stroke and cardiovascular disease prevention. The breast cancer study demonstrates yet another preventive benefit of aspirin. Aspirin use could be a simple way for women to get protection for multiple health risks and they should be encouraged to take aspirin appropriately.

Colorectal cancer patients who took aspirin had a much better chance of surviving than non-users, even after being diagnosed, according to a new study. The study, written by researchers from Harvard Medical School, Massachusetts General Hospital and the Dana-Farber Cancer Institute, is being published in this week’s Journal of the American Medical Association. An abstract is available online.

"The improvements in outcomes were striking," wrote The New York Times' Roni Caryn Rabin. "Patients with colorectal cancer who regularly used aspirin before and after a diagnosis were almost one-third less likely to die of the disease than non-users. Patients who initiated aspirin use only after a diagnosis did even better and had half the risk of dying from the cancer, possibly because of differences in their tumors."

The patients were all being treated for nonmetastatic, or localized, cancers, and were followed for almost 12 years on average.

Aspirin not only relieves aches and pains, but it can also help prevent heart attacks and strokes. There is some confusion over exactly who should use aspirin to help their hearts and how they should use it. The U.S.Preventive Services Task Force has issued new recommendations to help doctors and consumers. Discussing these recommendations is Dr. Nieca Goldberg, associate professor of medicine at New York University and a member of Partnership for Prevention's Task Force for Appropriate Aspirin Use. Click on the media player directly below to listen to the podcast.