CAD patients with absolute risk of more than 10% should be put on low dose Aspirin therapy-Prof. Akbar Chaudhry


 Seminar on Medical Uses of Aspirin during  PAFP Familycon 2015

CAD patients with absolute risk of more than
10% should be put on low dose Aspirin
therapy - Prof. Akbar Chaudhry

Regular use of LDA significantly reduces morbidity,
mortality and vascular events - Prof. Javed Akram

ISLAMABAD: The first scientific session during the Mid Year Familycon 2015 organized by Pakistan Academy of Family Physicians in collaboration with SZABMU PIMS as well as Pakistan Aspirin Foundation held here on July 26th was devoted to Medial Uses of Aspirin. Prof. Javed Akram Vice Chancellor of Shaheed Zulfikar Ali Bhutto Medical University who is also current President of Pakistan Aspirin Foundation was the first speaker. He made a presentation on mode of action of Aspirin. He discussed in detail platelet adhesions and activation, platelet aggregation leading to thrombosis which eventually leads to myocardial infarction. Anti Platelet Trialists Collaboration study, he said, has showed that regular use of low dose Aspirin results in 30% reduction in morbidity and mortality and it is also known as poor man’s Statin. Aspirin works in primary as well as secondary prevention. It is quite effective in unstable angina and prevents vascular events. Low dose Aspirin therapy overweighs benefits as compared to harm. Those who wish to donate blood, if taking Aspirin should stop Aspirin therapy at least ten days before donating blood.

Dr. Aftab Iqbal President Pakistan Academy of Family Physicians
presenting a mementoe to Prof. Javed Akram VC SZABMU at
the Familycon 2015 Mid Year Conference held at Islamabad on
July 26th2015. Also seen in the picture are Prof. Maj. Gen.
M.Aslam VC UHS, Dr. Altaf Cheema and others.

Continuing Prof. Javed Akram said that Aspirin was a wonder drug which continues to surprise us every day with its new and emerging indications. It is very effective in antiphospholipid syndrome and quite useful in infertility. The reported resistance to Aspirin was just about 9%.  Most often we use 75mg of Aspirin for long term use but in some cases like stroke, upto 150 Mg is used which is quite safe and effective. In severe cases it can be combined with clopidogrel. Aspirin is a gold standard antiplatelet agents and all other antiplatelet are judged while comparing with Aspirin. In acute MI, soluble Aspirin should be used for immediate effect which reduces mortality by 23%, he added.

Prof. Akbar Chaudhry an eminent physician, former President of Pakistan Aspirin Foundation who is currently Principal of Azra Naheed Medical College in his most comprehensive presentation on Medical Uses of Aspirin discussed in detail its well established indications.  Speaking about the real threat to urban health, he pointed out that about 7.8 million deaths occur annually in developing countries due to coronary artery disease. Cardiovascular diseases also account for 29% of global deaths and 82% of CVD deaths are in poor and low income countries. Cardiovascular diseases are also more prevalent in India, China and it is reported that almost 25% of people above the age of forty years suffer from coronary artery disease.

Prof. M. Akbar Chaudhry and Dr. Shehryaar Bhatti speaking at the Familycon 2015
meeting by PAFP held at Islamabad on July 26, 2015.

In Pakistan, Prof. Akbar Chaudhry said, we develop cardiovascular diseases a bit early; hence we should lay more emphasis on prevention which is also cost effective rather than on treatment of these diseases.  Some of the known risk factors for CAD which can be modified include hypertension which accounts for almost 18%, diabetes mellitus from which 6.9 million people are suffering in Pakistan, dyslipidaemias account for 27.54%, obesity which accounts for 46-68% and metabolic syndrome 34-49%. Smoking cessation, physical activity, diet therapy, weight control, blood pressure, lipids and diabetes control should be combined with regular use of low dose Aspirin Therapy. At present   37.6% Aspirin use is in cardiovascular diseases and its regular use reduces mortality by 25% in MI but if it is combined with clopidogrel, the mortality reduction can be up to 45%. If we treat one thousand patients with low dose Aspirin, we will prevent thirty Myocardial Infarction and angina.  As regards its usage in primary prevention, it leads to one third reductions in Myocardial Infarction and one sixth reduction in vascular events.  Following are the well established indications for use of aspirin therapy:

  1. Acute Myocardial Infarction
  2. Acute Coronary Syndrome
  3. Secondary prevention of AMI
  4. Primary prevention of CAD
  5. Acute Ischemic Strokes
  6. Transient Ischemic Attacks
  7. Primary and Secondary Prevention of Strokes
  8. Hypertension
  9. Diabetes Mellitus
  10. Acute Rheumatic fever
  11. Prophylaxis against DVT and  Pulmonary Embolism

Continuing Prof. Akbar Chaudhry said that those CAD patients who have an absolute ten years risk of less than 6% should not be prescribed aspirin therapy but those whose risk is between 7-9%, it should be patient’s choice and this should be discussed with the patient. However in those CAD patients whose absolute ten years risk is over 10%, they must be put on Low Dose Aspirin therapy. Use of enteric coated Aspirin in low dose is quite safe and effective in long term use. It will result in 46% reduction in unstable angina, 33% reduction in stable angina. Despite the fact that the safety and efficacy of Aspirin has been very well established in numerous studies, even then it is quite under used. Pakistan Aspirin Foundation, Prof. Akbar Chaudhry said conducted Aspirin Usage and Awareness Study some years ago which revealed that only 16% of patients got Aspirin at home when they suffered from chest pain, only 20% of these patients were prescribed Aspirin by Family Physicians within six hours of MI while Aspirin use in Emergency Room was 60% and 71% in the Ward. However, what was more surprising was the fact that only 50% of these acute coronary syndrome patients were prescribed low dose aspirin therapy on discharge. This prompted us to start these CME programmes to create awareness among public as well as healthcare professionals about the use of Aspirin.  Now a latest study Climate Asia has showed that 31% of patients were taking Aspirin for primary prevention, 43% of patients were already on low dose Aspirin therapy, 92% of these ACS patients were prescribed Aspirin whereas 42% were using it along with Clopidogrel. Patients suffering from Type 2 Diabetes Mellitus should also be put on low dose aspirin therapy using 150mg daily.

Prof. M. Akbar Chaudhry, Dr. Aftab Iqbal Sheikh President PAFP,
Prof. Javed Akram VC SZABMU, Prof. Waris Qidwai performing
the cake cutting ceremony celebrating the 20 Years of launch
of Ascard after the seminar on Medical Uses of Aspirin
organized during the Mid Year Familycon 2015 
held at Islamabad on July 27th 2015.

Speaking about the new and emerging indications for Aspirin therapy Prof. Akbar Chaudhry mentioned colorectal cancer, prostate cancer, pre eclampsia, DVT, pulmonary embolism, insulin resistance etc. In high risk cases it should be combined with Statins. Some of the contraindications for use of Aspirin therapy include allergy to Aspirin, active peptic ulcer disease and other blood disorders. It should also be used with caution in people over eighty years of age.

Earlier Mr. Shaukat Ali Jawaid General Secretary of Pakistan Aspirin Foundation gave a historical background of the formation of PAF, its activities and accomplishments so far. He mentioned the series of CME programmes which are being organized all over the country in collaboration with various professional specialty organizations and PMA in different cities which are all sponsored by Atco Laboratories. Publication of Book on Aspirin, publication of a booklet in Urdu besides revision and updating the Guidelines on Medial Uses of Aspirin. These revised guidelines were finalized by a panel of experts headed by Prof. Abdus Samad. Other members included Prof .Ejaz Ahmad Vohra, Prof. M. Akbar Chaudhry, Mr. Shaukat Ali Jawaid while a large number of eminent physicians have also contributed to this document. Lt.Gen. Mahmud Ahmad Akhtar former Surgeon Gen. of Pakistan Army has also made significant contribution to the development and finalization of these Guidelines which are now being distributed among the healthcare professionals. Pakistan Aspirin Foundation, Mr. Shaukat Ali Jawaid further stated has a very democratic set up, office bearers are elected every two years. Its website gives details of members, CME activities, achievements and accomplishments so far. It also has the latest revised Guidelines on Medical Uses of Aspirin.  Its membership is open to Healthcare professionals and public and life membership is just Rs. 2,000/- (Rupees two thousand only). We are extremely grateful to Atco Laboratories for sponsoring our CME activities for the last many years but keeping up the professional ethics, we do not patronize any particular brand name of Aspirin and doctors are advised to use Aspirin in its well established indications and ensure its optimal usage which will go a long way in reducing morbidity and mortality in a wide range of diseases.