Regular use of Low Dose Aspirin therapy results in 30% reduction in CVD events-Prof.Javed Akram


Aspirin Session at Family Physicians Conference

Regular use of Low Dose Aspirin therapy results
in 30% reduction in CVD events-Prof.Javed Akram

Modify known risk factors & Aspirin therapy will significantly
reduce morbidity and mortality in CAD-Prof.M.Akbar Chaudhry

LAHORE: As a part of its Continuing Medical Education programme, Pakistan Aspirin Foundation organized a session on Medical Uses of Aspirin during the Pakistan Academy of Family Physicians‘s 24th annual conference at Lahore on February 9th 2014. The speakers included Prof. Javed Akram President of Pakistan Aspirin Foundation and Prof. M. Akbar Chaudhry Principal Azra Naheed Medical College Lahore. This session was chaired by Prof. Javed Akram.
Prof. Javed Akram in his presentation discussed the mode of action of Aspirin and talked at length about the platelet adhesions and activation, showed normal platelets flowing in the blood. He also talked about the Antiplatelet Trialists Collaboration study, use of Aspirin in primary and secondary prevention of CAD besides stroke. Regular use of low dose Aspirin he said, results in 30% reduction in cardiovascular events. Aspirin is life saving in Acute Myocardial Infarction. It is an orphan drug, as it is economically priced, there is not much profit, hence no one is interested in promoting it despite the fact that it in its well established indications, it reduces morbidity and morbidity significantly. In some cases iron deficiency is associated with Aspirin use but low dose is quite safe and it has more benefits than any adverse effects. It improves neutrophils function and is quite effective in Anti Phospholipid syndrome and may result in 50% increase in pregnancy in infertility cases. There are other antiplatelet agents as well but they are not as good and are also more expensive. It is a truly wonder drug as so far it has one hundred thirty indications, he added.

Prof. Akbar Chaudhry in his comprehensive presentation highlighted the safety and efficacy of Aspirin in a large number of indications and supplemented his talk with references from various international studies. Chronic diseases, he said, are going to be the real threat to urban health in the days to come and more people are expected to die from cardiovascular disease than any other cause. In 2020 CVD is reported to become the leading cause of death. Some of the known risk factors for CVD are hypertension, diabetes mellitus, hyperlipidemia, metabolic syndrome, obesity, and smoking. Speaking about risk intervention he suggested smoking cessation, physical activity, diet therapy, weight control and lipid control. He then talked about the clinical history of Aspirin uses and said that it was in 1974 that its efficacy in CVD and particularly in acute myocardial infarction were highlighted through research studies. Now its established uses include besides CAD, TIAs, Stroke, Hypertension, Diabetes Mellitus, colorectal cancer etc. In primary prevention of CAD Aspirin reduces non-fatal MIs by 32%. Aspirin should be used in patients who have a ten years absolute risk of more than 10%, while in case of those having 5% absolute risk, aspirin should not be used while in case ten years absolute risk is between 7-9%, discuss with the patient and prescribe low dose aspirin therapy if they agree.

Regular use of Aspirin reduces first MI by 33%, stroke by 25%, CVD deaths by 17% and in secondary prevention it reduces unstable angina by 46% and stable angina by 33%. Aspirin Awareness and Usage Study (AAUS) study conducted by Pakistan Aspirin Foundation ten years ago showed that only 16% patients used Aspirin at home when they felt chest pain, 20.8% of the family physicians prescribed Aspirin while 50% ACS patients were prescribed Aspirin on discharge. However, now due to the CME programmes by Pakistan Aspirin Foundation, the situation has improved a lot which is evident from the fact that a recent study has showed that 31% patients were using Aspirin for primary preventon while 92% of the ACS patients were prescribed Aspirin on discharge.

Talking about absolute contraindications to the use of Aspirin, he mentioned hypersensitivity to Aspirin, during pregnancy after 36 weeks while relative contraindications include breast feeding, bronchial asthma, severe hepatic and renal damage. After the age of eighty years, one has to be careful while using Aspirin but on the whole Aspirin is quite safe and effective antiplatelet agent which reduces morbidity and mortality in many medical disorders, he added.
Prof. M. Ashfaq talked about the role of combination therapy in hypertension. Tracing the history of anti hypertensives, he said, first it was diuretics which were followed by beta blockers, Calcium Channel Blockers, ACE Inhibitors and then came the ARBs. Patients usually do not take medications because of their side effects. But now we have drugs with placebo like side effects. Amlodipine and Valsartan is a good combination which is safe and effective combination which offers better compliance and gives better results. He described Hypertension, Diabetes Mellitus and Chronic Kidney Diseases as three sisters while Diabetes Mellitus was their mother. In future it is education of the patient and the family which will play an important role in the prevention and treatment of these chronic diseases. While treating hypertension start treatment at early stage and use combination therapy for better results, he remarked.
Prof. Kamran Chima from Services Medical Institute talked about Chronic Obstructive Pulmonary Disease. This disease, he said, results in significant economic burden. Dust, tobacco smoke, indoor and outdoor air pollution are some of the risk factors and COPD prevalence is reported to be between 10-20% in various countries. While in the developed countries, reduction in mortality has been noted from cardiovascular diseases and stroke of which 50% reduction is due to Aspirin, mortality from COPD was increasing. Breathing stops first and heart sinks later. In patients with shortness of breath, obstructive disease, assess the symptoms and the degree of airflow obstruction. Reduce symptoms and it will reduce risk should be the goal of therapy in COPD. Efforts should be made to prevent disease progression, prevent and treat exacerbations. Treatment consists of stopping smoking and physical activity. He also referred to therapeutic options and rehabilitation therapy.