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Aspirin use best for those with high coronary calcium, low risk of bleeding

Press releases may be edited for formatting or style | November 02, 2020 Cardiology X-Ray

The researchers used data from 2,191 participants with a mean age of 44 years who had CAC scans and follow-up information available. About 57 percent were female and 47 percent were Black.

Overall, about half of the participants had a CAC score of 0, suggesting little to no calcium buildup in their arteries. About 7 percent had a CAC score of more than 100, suggesting heavy calcium buildup. The rest had values in the middle (1-99).

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When Khera and his colleagues 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, when they used statistical modeling to see how many of the ASCVD events may have been prevented by aspirin use – based on values gleaned from a recent meta-analysis that informed the AHA and ACC guidelines – they found that 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, Khera says, meaning 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, Khera says, 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.

“Aspirin use is not a one-size-fits-all therapy,” says Khera, who holds the Dallas Heart Ball Chair in Hypertension and Heart Disease. “CAC scanning can be a valuable tool to help us tailor care to help more patients avoid a first heart attack or stroke.”

Other UTSW researchers who contributed to this study include Ezimamaka Ajufo, Colby R. Ayers, Rebecca Vigen, Parag H. Joshi, Anand Rohatgi, and James de Lemos. De Lemos holds the Sweetheart Ball-Kern Wildenthal, M.D., Ph.D. Distinguished Chair in Cardiology.

This study was supported by grant UL1TR001105 from the National Center for Advancing Translational Sciences, National Institutes of Health. Relevant financial interests of the authors are noted in the manuscript.


About UT Southwestern Medical Center
UT Southwestern, one of the premier academic medical centers in the nation, integrates pioneering biomedical research with exceptional clinical care and education. The institution’s faculty has received six Nobel Prizes, and includes 23 members of the National Academy of Sciences, 17 members of the National Academy of Medicine, and 13 Howard Hughes Medical Institute Investigators. The full-time faculty of more than 2,500 is responsible for groundbreaking medical advances and is committed to translating science-driven research quickly to new clinical treatments. UT Southwestern physicians provide care in about 80 specialties to more than 105,000 hospitalized patients, nearly 370,000 emergency room cases, and oversee approximately 3 million outpatient visits a year.

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