Summary of Chinese guidelines for aspirin

The purpose of this document is to keep a working list of Chinese guidelines with information on aspirin.   The guidelines themselves should be read for further information.

Primary prevention of cardiovascular disease 

Cardiovascular disease (CVD) is a growing health burden in China and primary prevention strategies are important because over 70% of those experiencing a first Coronary Heart Disease (CHD) event in China died outside of the hospital setting¹.
Primary prevention of CVD in China is a top priority, in particular lifestyle factors such as  smoking, diet, weight and increasing activity levels in order to reduce risk factors such as high blood pressure, high cholesterol and control diabetes².
CVD risk assessment is an important way to identify those at high-risk of CVD in the Chinese population without current CVD. Specific risk assessment tools for the Chinese population have been developed based the Chinese Multi –provincial cohort study.
The 2012 China National Plan for Non-Communicable diseases [NCD] prevention and treatment³ has clear targets for CVD prevention.  As well as lifestyle interventions such as diet, exercise, low salt intake and smoking cessation the National Plan for NCD also has an ambition to limit the incidence of stroke to under 5% and decrease stroke related mortality by 5%. China’s Medium- and Long-Term Plan of Preventing and Controlling Chronic Diseases aims to achieve a 10% reduction in CVD mortality rates by 2020 and 15% by 2025⁴.
China’s latest medium to long term plan for the prevention and treatment of chronic disease (2017-2025)⁵ is run by the Healthy China Initiative and has 8 strategic measures:

• Health education
• Early diagnosis and treatment to reduce morbidity in high risk groups
• Standardised treatment
• Comprehensive healthcare management – especially between treatment and prevention services
• Improving medical security policies to reduce public burden
• Controlling risk factors and developing a healthy supportive environment
• Innovation to help develop the healthcare service industry
• Using technology to improve monitoring, evaluation and innovation in research and development

Both the 2016 China guidelines of dyslipidemia management and the 2017 Chinese guidelines for CVD prevention have new recommendations for risk assessment in China.
The 2016 China expert consensus advocates that for individuals with a ten year arteriosclerotic cardiovascular disease (ASCVD)⁶ risk of greater than or equal to 10%, aspirin should be used for the primary prevention of CVD.

Secondary prevention of stroke prevention in China

The Chinese clinical guidelines for the secondary prevention of ischemic stroke and TIA recommend an optimal dosage of aspirin between 75 and 150 mg/day. A combination of aspirin and clopidogrel for 21 days is recommended for patients with minor stroke or high-risk TIA within 24 hours of onset⁷. These recommendations are based on the CHANCE trial⁸.

References CVD prevention

1.Chin J Cardiol, March 2012; Vol 40 No 3.

2. Walker J, Hutchison P, Ge J et al 2018 Aspirin:120 years of innovation. A report from the 2017 Scientific Conference of the International Aspirin Foundation. ecancer 12 813 https://doi.org/10.3332/ecancer.2018.813

3.The ministry of Health. China National Plan for NCD Prevention and Treatment 92012-2015). http://www.chinacdc.cn/en/ne/201207/t20120725  [accessed Jan 2019].

4. The Office of State Council, PRC. China’s medium and long term plan of preventing and controlling chronic diseases (2017-2015). Index n0,: 000014349/2017-00030. http://www.gov.cn/xinwen/2017-02/14/content_5167942.htm cited by Jiang Y, Mao F and Li Y et al Construction of China cardiovascular health index BMC Public Health 2018; 18: 937
5. Kong LZ china’s Medium-to-Long-Term Plan for the Prevention and Treatment of Chronic Diseases (2017-2025) under the Healthy China Initiative. Chronic Dis Transl Med 2017 Sept 3(3):135-137.
6. ASCVD http://tools.acc.org/ascvd-risk-estimator-plus/#!/calculate/estimate
7. Wang Y, Liu M and Pu C 2014 Chinese guidelines for secondary prevention of ischemic stroke and transient ischemic attack. Int J Stroke 2017; 12(3):302-320.

8.Wang Y, Pan Y, Zhao X et al Clopidogrel with Aspirin in Acute Minor Stroke or Transient Ischemic Attack (CHANCE) Trial: One-Year outcomes [j]. Circulation 2015; 132(1):40-46.

Primary prevention of colorectal cancer/all GI cancers

To be developed

Aspirin and pre-eclampsia

The International Federation of Gynecology and Obstetrics recommend that women identified as high risk of pre-eclampsia during first trimester screening should be given aspirin prophylaxis (150mg at night from 11-14 weeks gestation until delivery or the diagnosis of pre-eclampsia). They do not advocate a policy of low-dose aspirin for all pregnant women.
Poon LC, Shennan A, Hyett JA et al The International federation of gynecology and Obstetrics (FIGO) initiative on pre-eclampsia: a pragmatic guide for first-trimester screening and prevention. Int J Gynecol Obstet 2019; 145 (Suppl.1) 1-33. @ https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1002/ijgo.12802