Aspirin in chronic cardiovascular disease and acute myocardial infarction.
The ability of low-dose aspirin to irreversibly inhibit platelet-dependent cyclooxygenase provides a biologic mechanism to explain why this drug may decrease the risk of thrombotic cardiovascular events. Observational epidemiologic studies, both case-control and cohort, have suggested that aspirin might reduce the risk of cardiovascular disease by approximately 20 to 30%. An overview of 25 randomized trials of aspirin among individuals with a history of prior cardiovascular disease demonstrated that those receiving aspirin experienced a significant 25% reduction in the occurrence of "important vascular events," an endpoint that combines nonfatal myocardial infarction (MI), nonfatal stroke, and cardiovascular death. There were also significant 32% reductions in subsequent nonfatal MI, 27% reductions in nonfatal stroke, and 15% reductions in vascular mortality. Thus, individuals with a history of MI, stroke, transient ischemic attack, or unstable angina clearly benefit from aspirin. The Second International Study of Infarct Survival (ISIS-2) sought to determine if benefits would accrue if aspirin was given within the first 24 hours of suspected evolving MI. The aspirin group experienced a significant 23% reduction in 5-week vascular mortality compared with those receiving placebo. Aspirin was also associated with significantly fewer reinfarctions and strokes. Thus, among those with suspected evolving MI, aspirin significantly reduces the risk of reinfarction, stroke, and vascular mortality. These analyses indicate that aspirin is of proven value in the therapy of most patients who have survived MI, stroke, or unstable angina, as well as those evolving a suspected MI.(ABSTRACT TRUNCATED AT 250 WORDS)
Hennekens
C H
CH
Channing Laboratory, Department of Medicine, Harvard Medical School, Boston, Massachusetts 02146.
D000208:Acute Disease; D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000188:drug therapy*; D002908:Chronic Disease; D006801:Humans; D009203:Myocardial Infarction / Q000188:drug therapy*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use
D010975:Platelet Aggregation Inhibitors; D001241:Aspirin