We cannot prevent atherosclerosis but can reduce Athero-thrombotic events with Aspirin


 Breakfast Session on Aspirin during CARDIOCON 2017

We cannot prevent atherosclerosis but can reduce
Athero-thrombotic events with Aspirin

All high risk CVD patients should be put on regular
low dose Aspirin Therapy-Dr. Farooq Fawad

HYDERABAD: Scientific programme of the CARDIOCON 2017 held here recently started on November 25th 2017 with a Breakfast Session devoted to Medical Uses of Aspirin. This session was jointly chaired by Prof. Ejaz Ahmad Vohra an eminent physician and former President of Pakistan Aspirin Foundation along with Prof. Shahryar Sheikh former President of World Heart Federation and Prof. Feroze Memon. Dr. Shaukat Memon acted as the Moderator.  Apart from Prof. Ejaz Ahmad Vohra who talked about Use of Aspirin beyond Cardiovascualr disease, Dr. Fawad Farooq from NICVD was the other speaker who highlighted the use of Aspirin in prevention of cardiovascular disease. He pointed out that we cannot prevent atherosclerosis which leads to Ischaemic Heart Disease but we can reduce Athero-thrombotic events with Aspirin therapy.

Prof. Ejaz Ahmad Vohra along with Prof. Feroze Memon and Prof. Shahryar Sheikh chairing a session
on Medical Uses of Aspirin during
Cardiocon 2017 held at Hyderabad recently.

Prof. Ejaz Ahmad Vohra in his presentation discussed in detail the historical background to the development of Aspirin, the mechanism of action of Aspirin, safety and efficacy of Aspirin in ACS, CAD besides its new emerging indication in prevention of colorectal cancer.  Various studies, he said, have shown that regular use of aspirin reduces the long term risk of several cancers and the risk of distant metastasis. Drop in digestive cancer incidence is also linked to long term intake of Aspirin. Another study has shown that dual clopidogrel and aspirin treatment is safe regarding the cancer risk. This study has generated hypothesis that clopidogrel may reduce the cancer incidence. Aspirin also reduces the risk and severity of early recurrent stroke after TIAs as well as ischaemic stroke. Daily low dose aspirin given before sixteen weeks of gestation to women at high-risk of adverse pregnancy outcomes mitigates that risk. Randomized trials have also showed that combining a Statin with one or more antihypertensive drugs and aspirin improves treatment adherence rates and safely reduces Cardiovascualr risk factors in patients with Cardiovascualr diseases.   Use of the above medications along with folic acid is estimated to reduce the risk of IHD by 88% and stroke by 80% in individuals aged 51-65 years if taken for two years. In view of the high burden of NCDs, the developing countries, Prof. Ejaz Ahmad Vohra remarked should focus on getting prevention and treatment programmes right. Lifelong daily low dose Aspirin for secondary prevention of CVD is well established and is included in numerous guidelines.  Yet adherence to aspirin is a major problem as even in United States 46.9% of patients with Ischaemic vascular disease were prescribed antiplatelet medications in 2007-2008 while the rates were even lower in primary care.  As such it is important to promote the use of regular low dose aspirin therapy in its well established indications to prevent morbidity and mortality in various disorders.

Prof. Ejaz Ahmad Vohra along with Prof. Shahryar Sheikh presenting a Cheque of rupees five hundred
thousand to the representative of Citizen Foundation on behalf of M/s Atco Laboratories during the
Aspirin session in Cardiocon 2017. Picture on left also shows Prof. Feroze Memon besides
Mr. Akhtar Tahir and
Mr. Kashif Riaz from Atco Laboratories.

Dr. Fawad Farooq’s presentation was based on certain case scenarios wherein he discussed why and who should receive Aspirin for prevention of Coronary Artery Disease. He also talked about rationale of using antiplatelet, assessment of cardiovascular disease as well as bleeding risk and then deciding as to who should receive aspirin therapy.   Speaking about platelet cascade in thrombus formation he pointed out that platelet adhesions is followed by platelet activation, aggregation which results in plaque formation. Major manifestations of thrombotic events include ischaemic stroke, Transient ischemic attack, myocardial infarction, unstable angina and critical limb ischemia.

Cardiovascualr risk is calculated based on sex, age, race, total cholesterol, HDL, systolic blood pressure, treatment for high blood pressure, history of diabetes and smoking. As regards risk levels, less than 3% risk over ten years period is considered low risk, from 7.5 to 10% over ten years period is considered high risk. In case of low risk, there is no need to prescribe aspirin therapy, in medium risk discuss the pros and cons of aspirin and use patient’s preferences to decide what to do. However, in high risk all patients should be put on regular low dose aspirin therapy.  He concluded his presentation by stating that identifying and treating single risk factor is not enough to reduce the Cardiovascualr disease risk.  Comprehensive risk assessment and taking care of all modifiable risk factors along with Aspirin treatment should be the goal. However, all those patients with known coronary artery disease should receive Aspirin, he added.

Photographed during the cardiocon 2017 held at Hyderabad recently from (L to R) are Prof. Khawar
Kazmi, Dr. Tahir Saghir, Prof. Nadeem Qamar, Mr. Akhter Ali Tahir (Atco), Dr. Farooq Fawad
and Mr.
Kashif Riaz from Atco Laboratories.

At the end of session Prof. Ejaz Ahmad Vohra along with Prof. Feroze Memon presented a cheque of Rs. 500,000 to the representative of Citizen Foundation on behalf of Atco Laboratories. In order to fulfill its corporate social responsibilities, Atco Laboratories, it may be mentioned here has signed an MOU with Citizen Foundation to pay a percentage of its sale of Aspirin (Ascard) to them to promote education. Prof. Ejaz Vohra commended the initiative of Atco Laboratories and hoped that other pharmaceutical companies will also come forward and play their role to fulfill their corporate social responsibility. This session was organized by Pakistan Aspirin Foundation in collaboration with Atco Laboratories which are sponsoring CME programmes of the Foundation for the last many years.