The effectiveness of taking aspirin for coronary heart disease
Some pharmacological interventions have proven to be highly effective in preventing cardiovascular diseases (CVD). Reducing the risk during or immediately after the development of coronary heart disease (CHD) was achieved with the help of aspirin, β-AB and ACE inhibitors. Each of these drugs was effective in long-term secondary prevention among various subgroups of patients, and aspirin was effective for some groups and in primary prevention.
Aspirin for secondary prophylaxis. Aspirin therapy in patients with an already existing cardiovascular disease (CVD) reduces the risk of subsequent events by 25%. Meta-analyzes showed a clear decrease in mortality and non-fatal cardiovascular events (SSSob) among patients after myocardial infarction, cerebral stroke (MI), coronary artery bypass surgery (CC), angioplasty, peripheral artery surgery or angina.
In these meta-analyzes, it was found that doses of aspirin> 75 mg / day are effective, but a further increase in doses was not accompanied by an increase in efficiency. Conversely, doses of <75 mg / day resulted in an unreliable risk reduction of 15%. However, ACC / ANA recently reduced prophylactic doses of aspirin from 75-325 to 75-162 mg / day, based on anti-platelet studies that revealed no differences in efficacy at lower doses, but showed a reduction in the risk of bleeding.
Other antiplatelet drugs have no advantage over aspirin. In the analysis of ATS (Antiplatelet Trialists Collaboration), such drugs also did not have superiority. It is unclear whether clopidogrel has a slight advantage. Despite randomized trials involving thousands of patients and data on the comparative cost of drugs, their effectiveness is unclear. A recent study comparing the combination of clopidogrel and aspirin with aspirin monotherapy among high-risk patients did not reveal the benefits of combination therapy in reducing the incidence of MI, MI, or death from CVD, but the combination therapy increased the risk of both small and severe bleeding.
Although there is evidence to add aspirin to clopidogrel for some high-risk patients, such as acute ischemia or after stent placement, an increased risk of bleeding makes this strategy unacceptable for primary prophylaxis.
In the absence of contraindications, aspirin should be used for all patients with cardiovascular diseases (CVD). Other antiplatelet drugs with proven efficacy, such as clopidogrel, should be prescribed to patients who are allergic to aspirin or are intolerant. Cost-effectiveness for clopidogrel is less favorable than for aspirin; in addition, clopidogrel is associated with an increased risk of hemorrhage; therefore, clopidogrel should not be used instead of aspirin for primary prophylaxis. The data of the Coronary Heart Disease Policy Model showed that with the expansion of aspirin for secondary prophylaxis from the current level to reception by all patients, to whom it is indicated, the cost-effectiveness indicator for 25 years will be $ 11 thousand for QALY.