Arthur Siegel
McLean Hospital, USAPresentation Title:
Aspirin use guided by coronary artery calcium scoring for primary prevention in persons at risk due to subclinical coronary heart disease
Abstract
Advances in primary cardiovascular prevention depend upon enhanced risk stratification. Gated coronary artery calcium CT scanning reliably identifies persons at risk for major acute cardiac events including cardiac arrest and sudden death due to subclinical coronary atherosclerosis. Low-dose aspirin use guided by such scoring has been recommended to reduce the race-related risk for cardiac arrest in middle-aged male marathon runners, based on a 44% reduction in first heart attacks in healthy same-aged men in the final report on aspirin in the Physicians’ Health Study. Such use is also advised to decrease the age-related sudden cardiac death risk during recreational sports activity in elderly persons, supported by a 31% decrease in major acute cardiac events in individuals at moderate risk with the addition of aspirin to the polypill in the TIPS-3 trial. Beyond sports-related cardiac risk reduction, aspirin use guided by coronary artery calcium scoring may enhance primary prevention for persons with conditions in which inflammation promotes progressive coronary atherosclerosis. Patients with human immunodeficiency virus infection and autoimmune illnesses are cases in point. This same approach may be used when counseling patients on heart health in general medical practice. Beyond lifestyle modifications and pharmacotherapy if indicated by risk calculators, coronary artery calcium scoring offers independent prognostic information to identify those with subclinical coronary atherosclerosis for enhanced primary prevention with aspirin in the absence of contraindications.
Biography
Arthur J. Siegel, MD, is an associate professor of medicine at Harvard Medical School and a fellow in the American College of Physicians. His research on Boston marathon runners has enhanced the safety of the sport by transposing evidence-based clinical paradigms from hospital-based practice to the marathon’s medical tent. Prevention and treatment of acute cerebral edema due to exercise-associated hyponatremia mainly in young women and reducing risk for cardiac arrest mainly in middle-aged men are among these measures.
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