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All ASPIRIN SUMMARIES

ISSUE ONE – CHINA ADDENDUM 2017

ASPIRIN DISEASE PREVENTION AND CURRENT RESEARCH SUMMARIES

Table of Contents

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Aspirin ASCVD prevention in China

Update Chinese guideline on ASCVD primary and secondary prevention

Cardiovascular disease has become the leading cause of death in China with the development of China’s economy and improvement of living standard and lifestyle changes, the incidence of cardiovascular disease as well as CVD risk factors continues to increase1 .The newly released “Outline of Healthy Chinese 2030” advocated management strategy for chronic disease including cardiovascular disease changed from treatment into prevention. To achieve the early arrival of cardiovascular disease inflection point, the most effective prevention strategy is primary prevention.

Aspirin has been widely used in cardiovascular and cerebrovascular disease which plays an indispensable role in cardiovascular disease primary and secondary prevention with a most cost-effectiveness value. However the awareness of primary prevention needs to be improved. Actual usage rate of aspirin in clinical practice was 14.09% in primary prevention population, and 26.61% in secondary prevention population2. To standardize cardiovascular disease prevention and management, improve the awareness of primary prevention, Chinese society of cardiology updated guideline on ASCVD disease prevention which will be published in second quarter of 2017.

Chinese guidelines recommended whether patients without cardiovascular disease should take aspirin should refer to patients’ baseline CVD risk, those with a 10-years CVD risk> 10% should consider taking aspirin for primary prevention under doctor’s recommendation. According to the epidemiology of cardiovascular risk factors in Chinese, Chinese guideline developed a new stratified ASCVD risk assessment process considering hypertension was the most decisive parameter. For patients younger than55 years old with a moderate CVD risk, assessment of ASCVD lifetime risk was recommended to facilitate the early identification of individuals with high risk of ASCVD during the rest of their lives, and gave actively intervene at the early stage.

For patients with cardiovascular disease, Guideline3 recommended that once patients was diagnosed as cardiovascular disease low dose of aspirin should be the routine of clinical treatment among those without contraindications.

 

Published 2016 Chinese expert consensus on Aspirin use in patients with ASCVD

For standardized use of aspirin in primary prevention, Chinese consensus led by geriatrics branch of Chinese Medical Association defined 6 target groups for aspirin ASCVD primary prevention4 : 1) those 10 years ASCVD risk higher than 10% ,2) Hyperlipidemia patients, TC ≥7.2mmol/l or LDL-C≥4.9mmol/l, aged≥ 55years old, 3)diabetes patients aged ≥ 50years old, with at least one major risk factor ( family history of premature CVD, hypertension, smoking, Dyslipidemia or albuminuria), 4)hypertension patients with any 2 conditions below: male≥ 45years old or female≥ 55years old, smoking, low HDL-C<1.04mmol/l ,5) CKD patients with eGFR 30-45ml.min-1.1.73m-2, 6) those who do not meet above conditions but have any 4 items below: male≥45years old or female≥ 55years old, smoking, family history of premature CVD, BMI≥ 28Kg/m2, Dyslipidemia.

 

Publication: Aspirin 100 Q&A for clinical doctors

Standardized use of aspirin is a prerequisite for clinical benefit. For better understanding the preventive role of aspirin in ASCVD and appropriate use in clinical practice, Aspirin 100 Q&A for clinical doctors was published5. The brochure included common questions doctors were interested in, contents including basic pharmacological knowledge of aspirin, effect on primary and secondary prevention of cardiovascular disease, aspirin adverse effect and how to overcome, drug interactions, and matters needing attention in clinical use.

 

New research on antiplatelet therapy in Chinese

In a randomized trials conducted at 114 centers in China, clopidogrel with aspirin in acute minor stroke or transient ischemic attack concluded the combination of clopidogrel and aspirin is superior to aspirin alone for reducing the risk of stroke in the first90 days and does not increase the risk of hemorrhage. Among 2933 patients who underwent CYP2C19 analysis, 58.8% patients were carriers of loss of function alleles which was higher than western countries. And compare to aspirin alone, clopidogrel plus aspirin did not reduce the risk of new stroke in the subgroup of patients who were the carriers of CYP2C19 loss of function alleles6.

 

References

  1. Chen Weiwei, Gao Runlin, Liu Lisheng, et al. “Report on Cardiovascular Diseases in China (2015)” Abstract. Chinese Circulation Journal, 2016, 31(6):521-528.
  2. Yang Zhaojun, Shan Zhongyan, Tian Haoming, et al. Current status of aspirin use in cardiovascular prevention in some areas of China. Chinese Journal of Diabetes Mellitus, 2011,3(1):22-26.
  3. Chinese Society of Cardiology. Guidelines for diagnosis and treatment of ST-segment elevation myocardial. Chinese Journal of Cardiology, 2015,43:380-393.
  4. The Geriatrics Branch of Chinese Medical Association, Aspirin use in patients with atherosclerotic cardiovascular disease:2016 Chinese expert consensus statement. Chinese Journal of Internal Medicine, 2017,56(1):1-13.
  5. Xiaoying Li. Aspirin 100 Q&A for clinical doctors. People’s military medical press.
  6. Yilong Wang, Xingquan Zho, Jinxi Lin, et al. Association between CYP2C19 Loss-of-Function Allele Status and Efficacy of Clopidogrel for Risk Reduction among Patients with Minor Stroke or Transient Ischemic Attack. JAMA. 2016 Jul 5;316:70-8

 

Disclaimers

  • The information, views and opinions expressed on the International Aspirin Foundation website are not endorsed or approved by members of The Scientific Advisory Board unless otherwise stated.
  • The Information section on the website is compiled using current published information at the time of writing and whilst every effort has been made to avoid errors, professional clinical judgement is required to interpret the information given. The information given is referenced clearly for further analysis as required.
  • Every effort is made by The International Aspirin Foundation to see that no misleading or inaccurate data, statement or opinion appear on the website, The International Aspirin Foundation cannot be held responsible for any errors or for any consequences arising from the use of the information contained on the website.
  • The International Aspirin Foundation, its associates and The Scientific Advisory Board accept no liability whatsoever for the consequences of any such inaccurate or misleading data, information, opinion or statement.
  • Any information involving drug usage should only be followed in conjunction with the drug manufacturer’s own published literature in their own country.
  • Medical sciences evolve on a continual basis and therefore independent verification of the website content should be made.
  • The information, views, opinions and any other material provided on this website should not be relied upon as a substitute to professional medical advice in relation to any medical condition. The International Aspirin Foundation, its associates and The Scientific Advisory Board accept no liability whatsoever for any consequences arising from any reliance placed on such information, views, opinions and other materials in lieu of professional medical advice.

 

Professor Junbo Ge MD, FACC, FESC, FSCAI, Shanghai, China

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Daniel José Piñeiro

ASSOCIATE
Name
Daniel José Piñeiro
Academic Affiliations:
Full Professor of Medicine, Universidad de Buenos Aires, Argentina Trustee, Board of Trustees, American College of Cardiology
Professional Setting:
My academic experience includes more than 40 years as a practicing medical doctor, teacher, and researcher. I have fulfilled these appointments in settings of vital social engagement and impact, most notably at the Hospital de Clínicas “José de San Martín” of the Universidad de Buenos Aires, a public hospital with high academic recognition. Additionally, I currently hold the position of Full Professor of Medicine at that same University.
Academic Activities:
  • International Meetings Participations: 180
  • Books-Editor: 1
  • Books Chapters: 39
  • Refereed Full Articles: 118 (listed in Pubmed: 29)
  • Refereed Abstracts: 221
  • Editorial Boards: 10
Profesional Associations:
  • 2005 President, Sociedad Argentina de Cardiología.
  • 2011-2013 President, Inter-American Society of Cardiology.
  • 2011-2013 Member (ex-officio), Board of Directors, World Heart Federation
  • 2017-2018 Member (at large), Board of Directors, World Heart Federation
  • 2018-2021 Trustee, Board of Trustees, American College of Cardiology
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Chia

John Chia

Name
John Chia MBBS (Spore), MRCP (UK), FAMS (Spore)
Academic Affiliations:

Adjunct Associate Professor DUKE-NUS Graduate Medical School,
Consultant Oncologist Curie Oncology Singapore,
Visiting Consultant National Cancer Centre Singapore.

Discipline:

Medical Oncology

Scientific Interests:
  • Aspirin as adjuvant therapy in established cancers
  • Adoptive T cell therapy and Dendritic cell vaccines in the treatment of solid tumors
  • Clinical Trial Design and Management
Declaration of Conflicts of Interest:

In the past 3 years, I have received consultant fees from Tessa Therapeutics, Aslan Pharmaceuticals, Novartis, and AstraZeneca.

I received grant support for investigator-initiated research from:

  • National Medical Research Council Singapore
  • Bayer AG

I hold shares in:  Roche, BMS, AstraZeneca, Incyte, Teva Pharmaceuticals, Trillium Therapeutics, Compugen, Arrowhead pharmaceuticals, Emergex, QuantumDx and Halozyme Therapeutics

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Badimon

Lina Badimon

Name
Lina Badimon BSc, PharmD, PhD, FESC, FAHA
Academic Affiliations:
Director of the Cardiovascular Science Program (ICCC) at the Hospital Santa Creu and San Pau, IIB-Sant Pau; CIBER CV. Director of the Cardiovascular Research Chair of the Autonomous University of Barcelona and Director of the UNESCO Chair in Biomedical Sciences Training and Research.
Discipline:
Pharmacology, Cardiovascular Disease
Scientific Interests:
Cardio-metabolic diseases, thrombosis, atherosclerosis and ischemic heart disease
Declaration of Conflicts of Interest:

I received consultant and speakers fees from Amgen, AstraZeneca, Bayer, Lilly and Sanofi.

    Return to Scientific Advisory Board
    Ge

    Junbo Ge

    Name

    Junbo Ge

    Ge Junbo, male, was born in Wulian, Shandong province on Nov. 8, 1962. He is the member of Chinese Academy of Sciences, professor and doctoral supervisor. He received his doctor’s degree of Medicine from German Mayence University in 1993 and now works as the director for Shanghai Institute of Cardiovascular Disease and the Center for Stem Cells and Tissue Engineering, Fudan University. He is also the designate chairman of the Cardiovascular Disease Branch of Chinese Medical Association, council member of the Cardiovascular Angiography and Interventions Association, international consultant of the American Heart Association. In Dec. 2013, he was appointed as the vice president of Tongji University.

    Prof. Ge has been engaged in clinical and scientific research work of cardiovascular disease since 1987, and his research area covers the pathogenesis of coronary heart disease, early diagnosis and treatment plan optimization.

    Return to Scientific Advisory Board
    Langley

    Ruth Langley

    Name
    Ruth Langley PhD, FRCP
    Academic Affiliations:
    Professor of Oncology and Clinical Trials, MRC Programme Leader and Chair of the Cancer Group, MRC Clinical Trials Unit at UCL, honorary consultant in medical oncology at the Brighton and Sussex University Hospital.
    Discipline:
    Medical oncologist; trialist
    Scientific Interests:
    • Aspirin
    • Gastro-oesophageal malignancy
    • Transdermal oestrogen in the treatment of prostate cancer
    • Trials methodology
    Declaration of Conflicts of Interest:
    Has received honorarium from Bayer
    Return to Scientific Advisory Board
    Chan

    Andrew T Chan

    Name
    Andrew T. Chan MD, MPH
    Academic Affiliations:
    Chief, Clinical and Translational Epidemiology Unit, Vice Chair, Division of Gastroenterology, Massachusetts General Hospital, Boston, Co-leader, Cancer Epidemiology Program, Dana-Farber/Harvard Cancer Center, Boston.
    Discipline:
    Gastroenterology
    Scientific Interests:
    • The role of aspirin in the prevention of colorectal cancer and other cancers
    • The role of the gut microbiome in colorectal cancer and other chronic gastrointestinal diseases, including inflammatory bowel disease and diverticulitis
    • The role of diet and lifestyle in colorectal cancer and other chronic gastrointestinal cancers
    Declaration of Conflicts of Interest:

    AACR Honors Dr. Andrew T. Chan With 2019 AACR-Waun Ki Hong Award

    Click here to find the press release.

    I received consultant Bayer and Pfizer, Inc.

    I received grant support for investigator-initiated research from:

    • National Institutes of Health
    • National Cancer Institute
    • Crohn’s and Colitis Foundation
    • Bayer AG
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    Gaziano

    Mike Gaziano

    Name
    J Michael Gaziano MD, MPH
    Academic Affiliations:

    Professor of Medicine, Harvard Medical School; Chief Division of Aging, Brigham and Women’s Hospital; Director of Preventive Cardiology and Director of Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System.
    Discipline: Cardiology and Epidemiology

    Scientific Interests:
    I am a chronic disease epidemiologist with a particular interest in the roles that individual lifestyle choices (diet, exercise, smoking), metabolic factors (obesity, high cholesterol, and hypertension), and biochemical and genetic markers play on the risk of cardiovascular disease and other chronic illnesses. Also, of interest is the impact that vascular disease has on other organ systems, including cognitive dysfunction and renal disease. I have an interest in the design of large-scale trials and observational studies nested in large health care systems using big data analytic techniques.
    Declaration of Conflicts of Interest:

    I received consultant and speaker fees Bayer.

    I received grant support as a principal investigator or co-investigator for research from the VA, DOD, NIH, Merck and Kowa.

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    Pierre A Web Photo

    Pierre Amarenco

    Name

    Pierre Amarenco, MD, FAHA, FAAN

    Academic Affiliations:
    • Professor of Neurology at Paris-Diderot Sorbonne University 
    • Chairman of the Department of Neurology and Stroke Center; Bichat University Hospital
    • Co-Director INSERM Unit-698 “Clinical Research in Atherothrombosis”
    Discipline:

    Neurology and Vascular Neurology

    Scientific Interests:
    • Understanding and preventing stroke and vascular diseases
    • Clinical trials in prevention of vascular diseases
    • Carotid intima-media thickness studies
    • Lipid trials: prevention and therapeutic –protective- evaluation
    Declaration of Conflicts of Interest:

    N/A

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    CarloPatrono

    Carlo Patrono

    CHAIR
    Name
    Carlo Patrono MD, FESC, FRCP
    Academic Affiliations:
    Adjunct Professor of Pharmacology at the Catholic University School of Medicine in Rome (Italy) and at the Perelman School of Medicine of the University of Pennsylvania in Philadelphia (USA).
    Discipline:
    Clinical Pharmacology
    Scientific Interests:
    • Studying platelet activation and inhibition in diabetes mellitus
    • Studying platelet activation and inhibition in myeloproliferative neoplasms
    • Investigating the mechanism of action of low-dose aspirin in preventing colorectal cancer
    Declaration of Conflicts of Interest:

    I received consultant and speakers fees from Acticor Biotech,  Amgen,  Bayer, GlaxoSmithKline,  Tremeau,  Zambon.

    I received grant support for investigator-initiated research from:

    • AIFA (Italian Drug Agency)
    • Bayer AG
    • Cancer Research UK
    • European Commission, FP6 and FP7 Programmes

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