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Cardiovascular Disease and the
Benefits of Aspirin Therapy
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Cardiovascular
disease (CVD) is a broad term used to describe a range of diseases that affect
the heart or blood vessels. The various diseases that fall under the umbrella
of CVD include coronary artery disease, heart attack, heart failure, high blood
pressure and stroke. The term "cardiovascular disease" is often used
interchangeably with heart disease because both terms refer to diseases of the
heart or arteries.[i]
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Despite recent
medical research advances, CVD, including heart attack and stroke, is the
leading killer of men and women and is the most costly cause of death in men
and women in the United States according to the American Heart Association
(AHA).
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An estimated 80
million American adults (1 in 3) have one or more types of CVD.[ii]
- It is estimated
that CVD causes 1 in every 5 deaths in the United States. Nearly every 25
seconds someone in the US will suffer a coronary event. About every minute,
someone will die from one.[iii]
- Coronary artery
disease (CAD) is caused by atherosclerosis and leads to angina pectoris and
myocardial infarction (MI). CAD caused about 445,000 deaths in 2005 and is the
leading single cause of death in America today. There are almost 17 million
individuals with a history of MI and/or angina.
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This year an
estimated 785,000 Americans will have a new coronary attack and about 470,000
will have a recurrent attack. It is estimated that an additional 195,000
silent heart attacks occur each year. Stroke affects 8.5 million people.[iv]
- Direct and
indirect cost of CVD in the U.S. is projected to be in excess of $150 billion
annually.[v]
Aspirin Recommended for Prevention
of Heart Attacks and Strokes
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Aspirin is one
of the most extensively studied drugs in history, with a well-established
efficacy and safety profile across a range of doses for preventing CVD
including heart attack and recurrent stroke. It has been incorporated into the
American Heart Association clinical guidelines for the secondary prevention of
cardiovascular events.
-
50 million
Americans use aspirin regularly for cardiovascular disease prevention.[vi]
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Aspirin has
become the standard in reducing risk of a second heart attack. A daily aspirin
regimen for people who have experienced a previous heart attack reduces the
risk of a second heart attack by about one-third.[vii]
-
The Food and
Drug Administration (FDA) has approved regular aspirin use to prevent a stroke
in people who have suffered a transient ischemic attack (TIA or mini-stroke). Aspirin
also helps prevent a second or recurrent stroke.[viii]
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Although the CVD
benefits of aspirin are well established, the use of aspirin is associated with
the clinically important risk of upper gastrointestinal bleeding (UGIB). The
use of aspirin is associated with a 2- to 4-fold increased risk of UGIB. In
addition, aspirin use for CVD is an important cause of gastrointestinal
bleeding-related death.
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The use of
proton pump inhibitors (PPIs) such as omeprazole can significantly reduce the
risk of upper gastrointestinal bleeding. ACC/AHA issued a Clinical Expert
Consensus in 2008 with the following recommendation: PPIs are the preferred
agents for the therapy and prophylaxis of aspirin-associated gastrointestinal
injury.
-
Using
in
vitro platelet testing, a drug-drug interaction has been reported between
PPIs such as omeprazole and clopidogrel. The clinical significance of this
drug-drug interaction on cardiovascular outcomes has not been established.
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