Risk assessment and aspirin use in Asian and Western populations

Abstract

Objective: The aim of this review was to examine aspirin utilization, cardiovascular risk estimation, and clinical evidence for aspirin prophylaxis in Asian versus Western countries.

Methods: A literature search was performed using PubMed and the key terms "aspirin" and "Asia" or "Western".

Results: Despite the growing burden of cardiovascular disease (CVD), aspirin is underutilized in high-risk patients in both Asian and Western countries. A number of risk estimation scores are available; however, validation is needed in countries such as Japan, India, and in South Asia. Underutilization of aspirin in Asia may be linked to an overestimation of bleeding risks. It is possible that a higher prevalence of Helicobacter pylori infection and genetic differences may make Asians more susceptible to gastrointestinal bleeding. Very low aspirin doses and even the wider use of gastroprotective agents may be the optimal approach to high-risk patients in Asia.

Conclusions: Based on the current evidence, aspirin should be used for CVD prevention when the risk:benefit ratio is favorable. A number of trials are underway, including the Diabetic Atherosclerosis Prevention by Cilostazol and Japanese Primary Prevention Project, which will provide key data on the benefits of aspirin in Asian patients at risk of CVD, and may improve aspirin utilization and risk estimation.

Keywords: Asia; Western; aspirin; cardiovascular risk estimation.

Figure 1

Risk factors can be divided into those that are predictive, those that are treatment targets, and those that fall into both categories. Copyright © 2007, Elsevier. Reproduced with permission from Gaziano JM, Manson JE, Ridker PM. Primary and secondary prevention of coronary heart disease. In: Libby P, Bonow RO, Mann DL, et al, editors. Libby: Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, PA: Saunders; 2007;1119–1148. Abbreviations: ACE, angiotensin-converting enzyme; ARB, angiotensin receptor blocker; CABG, coronary artery bypass graft; CRP, C-reactive protein; EBT, electron beam tomography; ECHO, echocardiography; ETT, exercise tolerance test; FH, family history; PCI, percutaneous coronary intervention.

Figure 2

Comparison of Framingham model and Chinese prediction model on ischemic CVD and CHD incidence in a Chinese cohort. Copyright © 2006. Reproduced with permission from Wu YF, Liu XQ, Li X, et al. Estimation of 10-year risk of fatal and non-fatal ischemic cardiovascular diseases in Chinese adults. Circulation. 2006;114(21):2217–2225. Abbreviations: CHD, coronary heart disease; ICVD, ischemic cardiovascular disease.

Figure 3

Summary of recommendations for low-dose aspirin therapy from the US Preventive Services Task Force. Abbreviations: CHD, coronary heart disease; CVD, cardiovascular disease; GI, gastrointestinal; MI, myocardial infarction.