Prof Soumitra Kumar
The rising burden of cardiovascular disease (CVD), especially among individuals under 55 years, highlights the urgent need for effective prevention strategies. Statins and aspirin are critical in preventing atherosclerotic cardiovascular disease (ASCVD). Statins reduce cholesterol[1], while aspirin mitigates platelet aggregation, providing a strong potential benefit against CV events.
Aspirin, long used for ASCVD prevention, significantly reduces the risk of both fatal and nonfatal myocardial infarction (MI).[2] A pivotal 26-year follow-up study from National Health and Nutrition Examination Survey (NHANES) III showed that regular aspirin use (≥30 times per month) in individuals with elevated lipoprotein(a) [Lp(a) ≥50 mg/dL] led to a 52% reduction in ASCVD mortality.[3] Aspirin lowers Lp(a) levels by suppressing apolipoprotein(a) mRNA in the liver, while its anti-inflammatory and antithrombotic effects reduce the risk of thrombosis and inflammation.[4]
Discontinuing aspirin triples thrombotic risk within 10 days of cessation.[5] Digital tools, like the Aspirin-Guide App, help clinicians balance CV benefits with bleeding risks to optimize its use for preventing premature ASCVD.[6]
Aspirin reduces MI risk and, when combined with statins, provides optimal CV protection. A meta-analysis by Khan et al found that aspirin reduced MI risk by 15% in 10,000 adults, while statins further reduced both bleeding risk and MI, especially in those with elevated Lp(a) or high ASCVD risk.[7]
In conclusion, the combination of aspirin and statins offers a crucial strategy for preventing ASCVD, especially in individuals with elevated Lp(a) and a high risk of ASCVD. Given the urgency of effective primary prevention, optimizing the use of these therapies can significantly reduce cardiovascular events and improve outcomes.
References
- Bansal AB, et al. HMG-CoA reductase inhibitors. [Updated 2023 Jul 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK542212/.
- Tsimikas S. What is the role of aspirin in primary prevention in patients with elevated Lp(a)?. Cardiometab Syndr J. 2023;3(1):41-51.
- Razavi AC, et al. Aspirin use for primary prevention among US adults with and without elevated lipoprotein(a). Am J Prev Cardiol. 2024;18:100674.
- Masson W, et al. Aspirin use in patients with elevated lipoprotein(a): Impact on cardiovascular events and bleeding. Curr Probl Cardiol. 2024;49(11):102827.
- Rodríguez LA, et al. Discontinuation of low dose aspirin and risk of myocardial infarction: case-control study in UK primary care.BMJ. 2011;343:d4094.
- Aspirin Guide. Retrieved on 14th October 2024 from http://www.aspiringuide.com/nav/1.
- Khan SU, et al. Aspirin with or without statin in individuals without atherosclerotic cardiovascular disease across risk categories. JACC Adv. 2023 8;2(2):100197.
Prof Soumitra Kumar is Prof. & HOD, Cardiology, Vivekananda Institute of Medical Sciences, Kolkata