Are the current recommendations for the use of aspirin in primary prevention of cardiovascular disease applicable in low-income countries?
Although evidence has accumulated that long-term aspirin therapy is beneficial in secondary prevention of cardiovascular disease (CVD), a lot of controversies persist regarding the benefit of aspirin use in primary prevention of CVD. In low-income countries (LIC) specifically, the decision to prescribe aspirin for primary CVD prevention is more problematic, as there is a dearth of evidence in this regard. Aspirin has been shown to have relative beneficial effects in preventing a first myocardial infarction, but not stroke. However, as stroke is the prevailing CVD in many LIC, especially in Africa, the benefit of aspirin in these settings is therefore questionable. Indeed, there is no published trial that has evaluated the benefits and risks of continuous aspirin therapy in populations of LIC. Furthermore, though cardiovascular risk assessment is crucial in decision-making for the use of aspirin in primary prevention of CVD, there are no risk assessment tools that have been validated in African populations. Studies are urgently warranted, to determine the usefulness of aspirin in primary prevention of CVD in low-income settings where the drug is highly available and affordable, as CVD is becoming the leading cause of deaths in LIC.
Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa ; Medical Diagnostic Center, Yaoundé, Cameroon.
Jean Jacques N
JJ
Noubiap
Sickle Cell Disease Unit, Mother and Child Centre, Chantal BIYA Foundation, Yaoundé, Cameroon ; Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.
Jobert Richie N
JR
Nansseu
D000349:Africa / Q000453:epidemiology; D001241:Aspirin / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D002317:Cardiovascular Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D003906:Developing Countries / Q000191:economics; D016527:Drug Costs; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D011203:Poverty / Q000191:economics; D017410:Practice Guidelines as Topic / Q000592:standards; D011322:Primary Prevention / Q000191:economics / Q000379:methods* / Q000592:standards; D018570:Risk Assessment; D012307:Risk Factors
D002317:Cardiovascular Agents; D001241:Aspirin
aspirin; cardiovascular disease; low-income countries; primary prevention