Aspirin for primary cardiovascular prevention: Why the wonder drug should not be precipitously dismissed

Primary cardiovascular prevention is the combined set of actions aimed at reducing the likelihood of symptomatic atherosclerotic disease or major adverse cardiovascular events (MACEs) in currently asymptomatic individuals. Older studies on aspirin for primary prevention were positive or neutral as to the primary ischemic endpoint (often represented by MACE), but the reduction in nonfatal ischemic events seemed largely counterbalanced by an increase in bleeding events. The 3 latest large randomized controlled trials on aspirin in primary prevention, all published in 2018, reached basically similar conclusions, leading to an intense debate on whether aspirin therapy is warranted in asymptomatic patients and whether there are subgroups that may benefit. In the present review, we provide an overview of the available evidence on aspirin for primary cardiovascular prevention, focusing on the results of meta-analyses and on strengths and pitfalls of meta-analytic assessments. Based on a meta-regression of the benefits and harm of aspirin therapy in primary prevention as a function of the 10-year risk of MACE, which is an alternative type of pooled analysis of available evidence, we propose a treatment algorithm acknowledging differences among patients and emphasizing the need for an individualized assessment of benefits and risks. Following general preventive measures (physical exercise, smoking cessation, treatment of hypertension and hypercholesterolemia, etc), a tailored approach to aspirin prescription is warranted. When patients are younger than 70 years of age, clinicians should assess the 10-year cardiovascular risk: when such risk is high and bleeding risk is low, aspirin treatment should still be considered, also taking patients' preferences into account

Aspirin for primary prevention of cardiovascular disease: Advice for a decisional strategy based on risk stratification

The need for aspirin therapy as part of primary prevention of cardiovascular (CV) disease is currently being highly debated, especially after 3 studies in different settings reported that a reduction in ischemic events is largely counterbalanced by an increase in bleeding events. One possible explanation for these results is the progressive reduction in the risk of major adverse cardiovascular events (MACE) as a result of primary prevention, which has accompanied global education programs that have led to patients smoking less, exercising more, and increasingly undertaking lipid-lowering therapies. Based on a meta-regression of the benefits and harmful effects of aspirin therapy in primary prevention as a function of the 10-year risk of MACE, we favor a differentiated and personalized approach that acknowledged differences between patients and emphasized an individualized assessment of benefits and risks. Following general preventive measures (physical exercise, cessation of smoking, treatment of hypertension and hypercholesterolemia, etc.), an individualized approach to prescribing aspirin is still warranted. When patients are less than 70 years of age, clinicians should assess the 10-year CV risk. Aspirin treatment should be considered only when the CV risk is very high and the bleeding risk is low, after taking into account the patient's preferences

Cardiac biomarkers for outcome prediction in infant bronchiolitis: Too soon to discard troponin?

Background: Acute bronchiolitis, usually caused by the respiratory syncytial virus, is the most common cause of severe respiratory distress in infants. The clinical relevance of cardiac biomarkers for diagnosis and prognosis of bronchiolitis in infants is still controversial. Aim: This Editorial discuss the results of a recent on the clinical relevance of cardiac specific biomarkers, NT-proBNP and cardiac troponin I (cTnI) in 40 infants with bronchiolitis, 37% requiring admission in the ICU. Results: NT-proBNP levels were significantly associated with prolonged hospitalization and duration of oxygen therapy, while cTnI levels, measured with high-sensitivity (hs) methods, did not. Furthermore NT-proBNP was significantly correlated with left and right ventricular functional echocardiographic parameters, while hs-cTnI was not associated with any echocardiographic parameter. Discussion: Recent results confirm that NT-proBNP assay has a crucial role in the diagnosis, prognosis and follow-up of patients with cardiac disease not only in adult, but even in pediatric age). On the other hand, the clinical usefulness of assay of hs-cTnI and hs-cTnT in pediatric cardiology, at present time, may be greatly limited by the lack of reliable reference intervals. Conclusions: Further well-designed multi-center studies are needed to more accurately evaluate the clinical relevance of cardio-specific biomarkers, and in particular of hs-cTnI and hs-cTnT assay, on prognosis of infants with bronchiolitis