These people can get the best benefit from aspirin

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In a recent study from UT Southwestern, researchers found an X-ray test commonly used to assess the hardening of the arteries could help doctors decide whether the benefits of taking aspirin to prevent a first heart attack or stroke outweigh the risks of bleeding from its use.

They found that aspirin use is best for people with high coronary calcium and low risk of bleeding.

The findings could give doctors and patients more concrete guidelines for making this important decision.

The study is published in JAMA Cardiology. One author is Amit Khera, M.D.

Due to its anti-clotting properties, aspirin is prescribed as a preventive measure to patients who have already had cardiovascular events, such as a heart attack or ischemic stroke.

However, aspirin’s role in primary prevention – averting first heart attacks and strokes – has been unclear.

In the study, the team focused on a diagnostic test – coronary artery calcium (CAC) scanning – to see if it could help doctors make this important decision.

CAC scanning, a CT scan that scores the amount of calcium that lines the heart’s arteries, is commonly performed to detect the hardening of the arteries and risk of a heart attack or stroke.

The team used data from 2,191 participants with a mean age of 44 years who had CAC scans and follow-up information available.

Overall, about half of the participants had a CAC score of 0, suggesting little to no calcium buildup in their arteries. About 7% had a CAC score of more than 100, suggesting heavy calcium buildup.

When the team examined the rates of atherosclerotic cardiovascular disease (ASCVD) and bleeding in the study group, they found that both events increased in a graded fashion as CAC scores rose.

However, aspirin’s benefits only outweighed its risks for those with CAC scores above 100. For this group, the risk of ASCVD was about 15-fold, and the bleeding risk about threefold of those with a CAC score of 0.

Yet, this effect only held true for those whose inherent risk for bleeding was already low.

This means that in practice, as mentioned in the guidelines if someone has had prior significant bleeding episodes, risk factors for bleeding, or was on medications that increase bleeding, they should not take aspirin for primary prevention regardless of their CAC score.

Together, the findings reinforce new guidelines suggesting that aspirin for primary prevention is only appropriate for select patients and that CAC scanning can help doctors and patients make that decision.

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