Secondary cardiovascular prevention: aspirin cardio is the first lifesaver
Even today, after more than 120 years of history, aspirin cardio remains a mainstay of secondary prevention in patients who have had a cardiovascular event such as a stroke or heart attack
This was demonstrated by a study published in Lancet1 in 2020, the importance of which was perhaps somewhat overshadowed by the emerging Covid-19 pandemic.
Stroke or heart attack, the role of aspirin cardio
The study showed that thienopyridines, antiplatelet drugs capable of inhibiting P2Y12 activity, do not provide substantial benefits over cardioaspirin, which therefore remains the antiplatelet drug of choice for secondary cardiovascular prevention.
The meta-analysis was conducted on 9 trials conducted over the last 30 years, directly comparing cardioaspirin with the new antiplatelet drugs in a population of over 40,000 patients.
“All patients in secondary prevention must take an antiplatelet drug.
We tried to answer the question whether these new antiplatelet drugs give benefits compared to cardio aspirin, focusing on very significant endpoints for the patient, i.e. the impact on mortality and on the risk of a new heart attack or stroke” – explains the study coordinator, Professor Giulio Stefanini, cardiologist at Humanitas and professor at Humanitas University -.
The results showed that the benefits of thienopyridine therapy are marginal compared to those with aspirin cardio.
“To prevent a single myocardial infarction we need to treat 244 patients with the new antiplatelet agents, which is too high a number to justify the new therapy as a replacement for cardioaspirin,” continues Stefanini, “and moreover without any effect on the risk of mortality”.
1. Monotherapy with a P2Y12 inhibitor or aspirin for secondary prevention in patients with established atherosclerosis: a systematic review and meta-analysis
Lancet 2020; 395: 1487-95