Low Dose Aspirin Therapy has a role in primary prevention of cardiac disease in high risk individuals


 Aspirin in primary prevention of cardiovascular diseases
Low Dose Aspirin Therapy has a role in primary
prevention of cardiac disease in high risk individuals
Treating physicians should take individual patients into account
while deciding to start aspirin therapy-Dr. Fawad Farooq

Faisalabad: Pakistan Aspirin Foundation organized a Breakfast Session on Aspirin during the 7th International Diabetes & Endocrine Conference held at Faisalabad on February 10th 2019. Dr. Fawad Farooq Assistant Professor and consultant cardiologist at National Institute of Cardiovascualr Diseases Karachi was the guest speaker while the panel of experts included Prof. Abdus Samad, Prof. Akbar Chaudhry, Prof. Shahryar Sheikh, Prof. Ejaz Ahmad Vohra, Prof. Shahbaz Kureshi and Prof. Javed Akram.

Dr. Fawad Farooq in his presentation on role of Aspirin therapy in primary prevention of cardiovascular diseases pointed out that Aspirin was not out as regards primary prevention but the physicians needs to take into account individual patients while taking a decision. Low Dose Aspirin therapy has a role in those individuals at high risk of cardiovascular events as well as those who have a family history of Cardiovascualr diseases. Hence, it is important that the treating physician takes a decision on individual patient’s basis taking into account his history and likely risks of developing a cardiac event. However, its role in secondary prevention is well established.

Prof. Shahryar Sheikh alongwith Prof. Abdus Samad and Prof.Ejaz Ahmad Vohra
presenting a memento to Prof. Javed Akram during the Breakfast Session on
Aspirin at the international Diabetes and Endocrinology conference organized
by Prof.Ahmad Bilal from FMU at Faisalabad from 8-10th February 2019.

He discussed in detail the mechanism of action of Aspirin, the arterial endothelial disease which starts with athero thrombosis leading to thrombus formation followed by plaque rupture. Adhesions of platelets are followed by activation and then aggregation which eventually leads to myocardial infarction. Aspirin has an important role in these patients as it is the most safe, and cost effective antiplatelet agent which reduces the morbidity and mortality which has been proved in numerous studies. There are numerous anti-platelet agents available in the market but Aspirin is the most effective and affordable drug for a vast majority of patients. Those patients in which Aspirin is contra indicated can be put on other antiplatelet agents. He also referred to the use of dual antiplatelet therapy using Aspirin along with clopidogrel but one has to be mindful of increased risk of bleeding. As regards its role in primary prevention, one needs to adopt a cautious approach as Aspirin was not yet out and it has its role as an effective antiplatelet agent.

Group photograph taken at the conclusion of Breakfast Session on Aspirin held on February 10th 2019 during the
international conference on Diabetes and Endocrinology organized by Prof. Ahmad Bilal form FMU at Faisalabad
shows many distinguished cardiologists and physicians from all over Pakistan who graced the meeting with their presence and helped Pakistan Aspirin Foundation to promote the use of Aspirin in its well established indications.

Earlier Prof. Javed Akram Vice Chancellor of University of Health Sciences, former President of Pakistan Aspirin Foundation who is the principal investigator of the proposed A4P study (Aspirin in Primary Prevention of cardiovascular diseases in Pakistani Patients) gave details about the study which will enroll thousands of patents at numerous centers all over the country. All the investigators will be trained and the study protocol is now being finalized. So far all the studies done with Aspirin, Prof. Javed Akram said, are in the West. We wish to see its effect in Asian patients which is a huge population in the world if we take into account the population of China, India, Pakistan and other Asian countires. All patients over the age of forty years, those suffering from diabetes and hypertension and other risk factors will be enrolled. The investigators will include cardiologists, internal medicine specialists, surgeons, gynecologists and even family physicians who are interested in participating in this study. He discussed in detail the objectives of the study, its rationale besides primary and secondary end points. If all goes well, this will be a landmark study done in Pakistani patients which will be sponsored by Higher Education Commission, Pakistan Science Foundation and other agencies but won’t be funded by any pharmaceutical company. Conceding to our request Atco Laboratories, Prof. Javed Akram said will provide us the placebo tablets for this double blind study for which the DRAP has been approached to get their approval.

The session was very well attended and a large number of participants actively participated in the discussion. The idea to start this study in Paksitan was very much appreciated. Responding to various questions regarding the use of low dose aspirin therapy, Prof. Abdus Samad speaking in his usual style remarked that one should look at the mileage a car has done and not on the model. Take history of the patient and look at the likely risk factors before taking any decision to start low dose aspirin therapy. In high risk patients and those who are likely to have cardiac events, one must put these patients on Aspirin therapy. In low risk adults, the treating physician should ask the patient, tell them the risk and benefits and then decision to start aspirin therapy should be taken. The patient should be involved in such a decision making process, he added.

 Prof. Javed Akram and Dr. Fawad Farooq speaking at the Breakfast Session
on Medical Uses of Aspirin on February 10th during the international
conference on Diabetes and Endocrinology organized by Prof. Ahmad
Bilal form FMU at Faisalabad from 8-10th February 2019.

It may be mentioned here that regular use of low dose aspirin therapy plays an important role in reducing morbidity and mortality in a wide range of medical disorders. Despite its proven efficacy, it is still under used even in its well established indications. Enteric coated aspirin is preferred as it is safe in long term use. It is also advisable to take Aspirin at bed time as it will take care of the early morning peak in blood pressure when most of the myocardial infarction occurs. Aspirin is a wonder drug which is life saving in acute myocardial infarction. Pakistan Aspirin Foundation organizes such CME activities to create awareness among public as well as educating the healthcare professionals to promote the use of Aspirin in its well established indications besides highlighting its emerging and new indications. These CME activities are sponsored by M/s Atco Laboratories. However, Pakistan Aspirin Foundation keeping up professional ethics does not promote any particular brand of Aspirin or any particular company. An announcement to this effect is always made at such meetings and it is also acknowledged that travel and accommodation of guest speakers, members of the expert’s panel is sponsored by M/s Atco Laboratories. Pakistan Aspirin Foundation is extremely grateful to M/s Atco Laboratories for this generous, unconditional support in promoting the use of Aspirin therapy.

At the end of the session Mr.Shaukat Ali Jawaid General Secretary of Paksitan Aspirin Foundation thanked the guest speaker Dr. Fawad Farooq, members of the expert’s panel besides Prof. Ahmad Bilal chief organizer of the conference for providing them an opportunity to have this Breakfast Session on Medical Uses of Aspirin. Mr. Kashif Riaz from Atco Laboratories thanked the participants for gracing the occasion with their presence.