Aspirin guided by coronary artery calcium scoring for primary prevention in persons with subclinical coronary heart disease

Title : Aspirin guided by coronary artery calcium scoring for primary prevention in persons with subclinical coronary heart disease

Abstract:

Advances in primary cardiovascular prevention depend upon enhanced risk stratification. Gated coronary artery calcium CT scanning independently identifies persons at increased risk for major acute cardiac events including sudden death due to subclinical coronary atherosclerosis. Low-dose aspirin use guided by such scoring has been recommended to reduce the transiently increased race-related risk for cardiac arrest based on a 44% reduction in first heart attacks in healthy middle-aged men in the final report on aspirin in the Physicians’ Health Study. This strategy may also decrease the age-related increasing risk for sudden cardiac death during recreational sports activity in older persons, as shown by a 31% decrease in major acute cardiac events in persons at moderate risk with the addition of aspirin to the polypill (TIPS-3 trial). Beyond exercise-related advantages, aspirin use guided by CACS may benefit patients with conditions which cause progressive coronary atherosclerosis consequent to inflammation. Examples include excess cardiovascular risk in persons with human immunodeficiency virus infection and increased sudden cardiac death risk in schizophrenia. Inexpensive and readily available worldwide, aspirin provides an opportunity to close the gap in access to preventive measures due to stigma associated with these conditions. As a standard of care in office practice, aspirin use for persons with subclinical coronary heart disease may reduce the frequency of untoward sudden cardiac deaths, which are the presenting symptom in up to 40% of fatalities due to coronary heart disease.

Biography:

Dr Siegel is an Associate Professor of Medicine at Harvard Medical School and a Fellow in the American College of Physicians. After completing internal medicine residency interrupted by military service in Vietnam, Dr. Siegel initiated a primary care practice at the Brigham in the early 1970s, which evolved into the teaching practice for the primary care residency program. He also founded the MGH Internal Medicine Associates, Belmont, MA, USA, embedded in McLean Hospital in the 1990s. His research on Boston marathon runners has enhanced the safety of the sport, including evidence-based treatments for cerebral edema due to exercise-related hyponatremia and low-dose aspirin use to reduce the transiently increased race-related risk for cardiac arrest.