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Low Dose Aspirin therapy leads to 23% reduction in MI mortality, 50% reduction in Non-fatal MI and Stroke - Prof. M. Ishaq.

Regular use of Low Dose Aspirin therapy leads to 23% reduction in mortality in Myocardial Infarction, 50% reduction in Non-fatal MI and Stroke. It is the most cost effective anti-platelet agent which is safe in long term use. Its use in primary prevention of heart disease is conditional and one should calculate the risk before prescribing it. This was stated by Prof. Muhammad Ishaq, a noted cardiologist and Secretary of Pakistan Hypertension League. He was making a presentation on Use of Aspirin in the prevention of cardiovascular diseases at a seminar organized here on Saturday January 27th 2018 by Pakistan Aspirin Foundation in collaboration with Pakistan Medical Association Sukkur.

Dr. Raj Kumar Head of the Dept.of Cardiology at Sardar Ghulam Muhammad Maher Medical College was the main organizer of this meeting. It was chaired by Prof. Abdus Samad an eminent cardiologist of Pakistan who is also former President and Chairman of Experts Panel of Pakistan Aspirin Foundation on Medical Uses of Aspirin. Others who jointly chaired the session included Dr.Zahoor Soomro, President of PMA Sukkur, Prof. Altaf Shaikh and Mr. Shaukat Ali Jawaid General Secretary of Pakistan Aspirin Foundation.

Prof. Ishaq in his presentation on Primary and Secondary prevention of coronary artery disease and the use of Aspirin pointed out that Aspirin is a lifesaving miracle drug which is considered an orphan drug. Since three is not much profit, no one is interested in its promotion. However, it is a fact that it is one of the most widely used drug. Quoting a Hadees Prof. Ishaq said that " there is a flesh in the body, if it is sound, one is healthy but if it is corrupt, it is very bad and serious and it is Heart".

Mortality from cardiovascular diseases Prof. Ishaq said is about 30%. Of this cardiovascular mortality 55% is due to CAD, 17% from stroke, 6% from Congestive Heart Failure and 5% from hypertension. Cardiovascular diseases, Peripheral Artery Disease and cerebrovascular diseases all affect at the same time. Tracing the history of Aspirin, Prof. Ishaq said that it was first used as pain killer as it offers potent pain relief. In 1967, its anti-platelet properties were discovered. PAD is very common in Pakistan. About 26 Million people in Untied States are at present using Aspirin daily. Heart disease is the main indication for its use. He then discussed in detail the thrombotic disease process, how platelets are formed, they aggregate, plaque formation and then clotting which results in heart attack. Aspirin, he stated, is the mother of all anti platelet agents. He also briefly talked about its mechanism of action. It kills all the platelets thus results in relief from stable and unstable angina.

The role of Aspirin in all sub-sets of Acute Coronary Syndrome patients is very well established. In coronary interventions, it offers maximum benefit i.e. 53% reduction in MI and Stroke as well as vascular death besides preventing second event. Various studies have confirmed that it leads to reduction in morbidity and mortality in AMI, Acute stroke, PAD, TIA and CAD. It is useful in high risk of embolism as well as in diabetes mellitus. In acute MI, one has to use soluble Aspirin one full tablet of chew three to four coated tablets for immediate relief. Soluble Aspirin should however be preferred in acute conditions. Despite its usefulness in a wide range of medical disorders, it is still under used in many countries including Pakistan. Speaking about the effective dosage, he said, 75-100mg is both effective. The only known side effect is bleeding but it has a very low toxicity profile.

It has high safety profile as compared to clopidogrel, small dose of up to 100mg has a risk of bleeding of 1.9% which is far less as compared to other NSAIDS which are so commonly used, he remarked.

In acute vasculitis in children it is safe and effective. Similarly it is used in Kawasaki Disease. Aspirin resistance is very low. In Diabetes Mellitus Type-2, if there is no clinical CAD, one should not use Aspirin but in case of any risk factor, its use is recommended. As regards use of Aspirin in primary prevention, there are different reports. American Heart Association says that if the CAD risk is more than 10%, use Aspirin. Joint British Society recommends the use of 75mg of Aspirin in all people over the use of fifty years. It is better to calculate the absolute risk of cardiovascular disease. If the risk is less than 6%, do not use it but if the risk if more than10%, use of low dose aspirin is recommended. In case of risk between 6-10%, ask the patient and go by his preference regarding use of Aspirin.

Responding to various questions Prof. Ishaq said that there is no doubt that Aspirin is a very effective analgesic and antipyretic but today we wanted to highlight its anti-platelet properties and usefulness in prevention of cardiovascular diseases.

Earlier Dr. Zahoor Soomro President of PMA Sukkur in his speech said that PMA keeps on organizing such CME programmes for its members which is also requirement of the PMandDC. Today's session has been organized in collaboration with Pakistan Aspirin Foundation. Proper use of drug in proper dosage at proper time saves lives. Aspirin is very useful in numerous cardiac conditions including AMI and Sudden Death. Aspirin is an important component of Medicine. In clinical practice a small tablet of Aspirin makes lot of difference. It is simple, economical and easily affordable and available everywhere. He suggested we all must keep Aspirin with us in our clinic, office and home as it may be needed in any emergency and it can prove lifesaving.

Dr. Raj Kumar in his address highlighted the usefulness of Aspirin which he said was a lifesaving, wonder drug. He also reminded the participates that they should always keep Aspirin with them and in case of chest pain irrespective of the fact whether it is cardiac or non-cardiac use it immediately. It is as effective as streptokinase.

Prof. Abdus Samad in his concluding remarks commended Prof. Ishaq for his excellent presentation on Aspirin. He further pointed that cardiovascular diseases is going to be the leading cause of death all over the world. Hence, its prevention is most important. If one does not wish to die due to CVD, it is important to take low dose aspirin daily. It is safe and effective even in long term use. Use of any drug, he further stated must be medically based. One should always look at benefits and side effects. Use the drug where benefit is more. Asian population in general he said was at a higher risk of developing cardiovascular disease even without smoking. If the risk is more than 6%, one must use Aspirin. Speaking in his typical style, he said that it is just like if the crime in the society is more, one should be careful in opening the door but if there is no crime, there is no harm in opening the door. Similarly use Aspirin if the risk is there.

Continuing Prof. Samad said that a person is as old as his arteries. We in Pakistan see CAD and PAD in patients in their 30s. If a seventy years old patient has good arteries, he may be very healthy. Age is in fact determined by the arterial age. Aspirin is known as Poor Man's Statin and it is as effective as Streptokinase. It is economically priced. We all must take care of our own health, our family's health and cost effective drugs like Aspirin should be preferred. Age, cholesterol, LDL and smoking are some of the important risk factors in Asian population. In Pakistan AMI occurs at a very young age, hence it is advisable that one should always calculate the risk of your patient which is easy to do and then prescribe low dose Aspirin therapy. If anyone gets CAD before the age of seventy years, it is considered his own fault as he or she failed to take preventive measures.

Speaking about the use of Aspirin in surgical procedures, Prof. Samad said that use of Aspirin should not be stopped in surgical procedures except in case of surgery in close cavity like brain surgery or chest surgery. In all other conditions one should continue the use of Aspirin. We have seen patients with MI soon after surgery as Aspirin was stopped. In young people, clot is more and less atherosclerosis. Use of low dose Aspirin has to be lifelong. We all must develop a habit of preventing coronary artery disease in our families and children as it is our duty. Avoid fast food and go for slow food. All heart disease patients should be advised to use Aspirin, Statin regularly unless there are some contra indications. Avoid soft drinks and all other sugary drinks, go for regular exercise, do not take tension, and avoid stress.

He also recalled that late Prof. Iftikhar Ahmad used to teach us that there is only one animal donkey which does not get heart attack because donkey works hard, does not complain, eats grass, and does not eat meat, beef, butter and other fats. Hence always prefer the use of vegetables, fruits, healthy diet, take no tension and work hard to avoid any heart attack.

Mr. Shaukat Ali Jawaid General Secretary of Pakistan Aspirin Foundation speaking on the occasion thanked Dr. Raj Kumar, Dr. Zahoor Soomro and PMA Sukkur. He also announced that though M/s Atco Laboratories have sponsored their visit and are sponsoring CME activities of Pakistan Aspirin Foundation for the last many years but we do not patronize any particularly pharmaceutical company or any particular brand name of Aspirin. We are extremely grateful to Atco Laboratories for their generous help and assistance which has gone a long way in creating awareness among public as well as healthcare professionals regarding the medical uses of Aspirin particularly it's effective in prevention of cardiovascular diseases. However, one must remember that with the use of every drug, there are some non-responders and Aspirin is no exception. Some people might still suffer from CVD despite taking Aspirin. At the end Prof. Altaf Sheikh thanked the speakers and the participants for making the meeting a great success.
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Publication:Pulse International
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Geographic Code:9PAKI
Date:Feb 28, 2018
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