Analysis of the Dilemma Involving Statins and Aspirin as Primary Prevention Alternatives in Cardiovascular Disease


Cardiovascular disease is one of the deadliest diseases in the world. Nowadays, alongside the developments of various medical therapeutic strategies, there is a decreasing trend of cardiovascular mortality. However, this reduction is not adequate and needs to be supported by cardiovascular prevention approaches. Statins and aspirin are two of cardiovascular drugs that are believed to be beneficial in cardiovascular prevention. Their magnificent efficacies in the secondary prevention setting lead them to be used in the primary prevention. However, some safety issues associated with the drugs should be considered. For that reason, based on previous trials and studies, some recommendations regarding the efficacy-safety issues are developed.


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1. Bhatnagar P, Wickramasinghe K, Williams J, et al. The epidemiology of cardiovascular disease in the UK 2014. Heart. 2015;0:1-8.
2. Townsend N, Bhatnagar P, Wilkins E, et al. Cardiovascular disease statistics, 2015. 2015. British Heart Foundation: London.
3. Sirtori CR. The pharmacology of statins. Pharmacological Research. 2014;88:3-11.
4. Awtry EH, Loscalzo J. Aspirin. Circulation. 2000;101:1206-18.
5. Espinosa EVP, Murad JP, Khasawneh FT. Aspirin: Pharmacology and clinical applications. Thrombosis. 2012;1:1-15.
6. Lim SY. Roles of statins in coronary artery disease. Chonnam Med J. 2013;49:1-6.
7. Takayama T, Hiro T, Ueda Y, et al. Plaque stabilization by intensive LDL-cholesterol lowering therapy with atorvastatin is delayed in type 2 diabetic patients with coronary artery disease—Serial angioscopic and intravascular ultrasound analysis. Journal of Cardiology. 2013;61:381-6.
8. Lima JAC, Desai MY, Steen H, et al. Statin-induced cholesterol lowering and plaque regression after 6 months of magnetic resonance imaging-monitored therapy. Circulation. 2004;110:2336-41.
9. Taguchi I, Oda K, Yoneda S, et al. Evaluation of serial changes in tissue characteristics during statin-induced plaque regression using virtual histology-intravascular ultrasound studies. Am J Cardiol. 2013; 111:1246-52.
10. Anonymous. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet. 1994;344:1383-9.
11. Sacks FM, Pfeffer MA, Moye LA, et al. Cholesterol and Recurrent Events Trial investigators. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. N Engl J Med. 1996;335:1001-9.
12. Sever PS, Dahlöf B, Poulter NR, et al. Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial—Lipid Lowering Arm (ASCOT-LLA): A multicentre randomised controlled trial. Lancet. 2003;361:1149-58.
13. Sever PS, Chang CL, Gupta AK, et al. The Anglo-Scandinavian Cardiac Outcomes Trial: 11-year mortality follow-up of the lipid-lowering arm in the UK. European Heart Journal. 2011; -:1-8.
14. Parekh AK, Galloway JM, Hong Y, et al. Aspirin in the secondary prevention of cardiovascular disease. N Engl J Med. 2013;368(3):204-5.
15. Antithrombotic trialists collaboration. Collaborative meta-analysis of randomized trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ. 2002;324:71-86.
16. Reiner Z, Catapano AL, De Backer G, et al. ESC/EAS guidelines for the management of dyslipidaemias: Addenda. European Heart Journal. 2011;1:1-18.
17. Reiner Z, Catapano AL, De Backer G, et al. ESC/EAS guidelines for the management of dyslipidaemias: the task force for the management of dyslipidemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). European Heart Journal. 2011;32:1769-818.
18. Perk J, De Backer G, Gohlke H, et al. European guidelines on cardiovascular disease prevention in clinical practice (version 2012): The fifth joint task force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). European Journal of Preventive Cardiology. 2012;19(4):585-667.
19. Collins GS, Altman DG. An Independent and external validation of QRISK2 cardiovascular disease risk score: a prospective open cohort study. BMJ. 2010;340:c2442.
20. NHLBI. Estimate of 10-year risk for coronary heart disease Framingham Point Scores. NIH Publication No. 01-3305. Retrieved from: Accessed 12 Mar 2016.
21. Ebrahim S, Taylor FC. Statins for the primary prevention of cardiovascular disease. BMJ. 2014; 348:1-6.
22. Cholesterol Treatment Trialists (CTT) Collaboration. The effects of lowering LDL cholesterolwith statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials. Lancet. 2012; 378:67-75.
23. Ridker PM. The JUPITER Trial: Results, controversies and implications for prevention. Circ Cardiovasc Qual Outcomes. 2009;2:279-85.
24. Ridker PM, Pradhan A, MacFayden JG, et al. Cardiovascular benefits and diabetes risks of statin therapy in primary prevention: An analysis from the JUPITER trial. Lancet. 2012;380:565-71.
25. Antiplatelet Trialists’ Collaboration. Collaborative overview of randomised trials of antiplatelet therapy prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. BMJ 1994; 308.
26. The Medical Research Council’s General Practice Research Framework. Thrombosis prevention trial: Randomised trial of low-intensity oral anticoagulation with warfarin and low-dose aspirin in the primary prevention of ischaemic heart disease in men at increased risk. Lancet. 1998;351:233-41.
27. Sirois C, Couture J, GrEgoire JP. Acetylsalicylic acid for primary prevention of cardiovascular diseases in older patients with diabetes: do the benefits overcome the risks? Ther Adv Drug Saf. 2012;3(5):213-26.
28. Wards SA, Demos L, Workman B, et al. Aspirin for primary prevention of cardiovascular events in the elderly: Current status and future directions. Drugs Aging. 2012;29(4):251-8.
29. NICE. Cardiovascular disease: risk assessment and reduction, including lipid modification. 2015;1:1-50.
30. National Center for Biotechnology Information. PubChem compound database; CID=2244, Retrieved from: Accessed 10 Mar 2016.
31. NICE. Antiplatelet treatment. 2015. Retrieved from:!topicsummary. Accessed 12 Mar 2016.
32. Dave T, Ezhilan J, Vasnawala H, et al. Plaque regression and plaque stabilisation in cardiovascular diseases. IJEM. 2013;17(6):983-9.
33. NICE. Cardiovascular disease prevention overview. 2016. Retrieved from: Accessed 19 Mar 2016.
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Analysis of the Dilemma Involving Statins and Aspirin as Primary Prevention Alternatives in Cardiovascular Disease. (2017). Indonesian Journal of Cardiology, 38(1), 38-48.
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