-
1.
Polymer-free and durable polymer drug-eluting stents may reduce the risk of stent thrombosis [132].
-
2.
In primary prevention, the risk of aspirin (i.e., bleeding) may exceed the beneficial reduction in CVD events in most patients, even among patients with diabetes mellitus [4,[133], [134], [135]]. Possible exceptions might include select diabetes mellitus patients not at increased bleeding risk, who are: (1) 40–70 years of age at high CVD risk [136]; (2) < 70 years of age at intermediate to high CVD risk (>5% 10 year CVD risk) [137], (3) ≥ 50 years with diabetes plus one additional major CVD risk factor (family history of premature atherosclerotic CVD, hypertension, dyslipidemia, smoking, or chronic kidney disease/albuminuria) [73].
-
3.
The standard of care for patients at thrombosis risk in secondary prevention (preventing recurrent ischemic events after acute coronary syndrome and to prevent stent thrombosis after percutaneous coronary intervention) includes dual antiplatelet therapy (DAPT). DAPT is typically defined as aspirin plus the use of a P2Y12 receptor inhibitor (clopidogrel, ticagrelor, or prasugrel) [138].
-
4.
Aspirin is the first drug of choice in lifelong administration in secondary prevention after a myocardial infarction [139]. Aspirin coated preparations may reduce gastrointestinal bleeding. The coated aspirin dose of 100 mg per day may help reduce CVD, death (and cancer), with lower doses being better tolerated (less bleeding) and higher doses having greater CVD risk reduction [140]. Aspirin doses of 75–100 mg per day may offer the optimal benefit:risk ratio in chronic prevention of recurrent thrombosis in patients with acute coronary syndrome [139] (81 mg “baby aspirin”).
-
5.
Acutely, older data supported aspirin as beneficial in patients with unstable coronary artery disease, acute myocardial infarction, and unstable angina [[141], [142], [143]]. Subsequent data supported aspirin platelet inhibition being fastest with chewable aspirin, which is faster-acting than soluble aspirin, which is faster-acting than whole solid aspirin, which is faster-acting than enteric-coated aspirin [144]. After calling 9-1-1 for emergency phone help, patients undergoing an acute myocardial infarction are often advised to chew one 325 mg aspirin slowly, preferably within 30 min of the onset of symptoms [145]. Acute administration of aspirin in patients with acute stroke is not recommended due to the potential of worsening a hemorrhagic stroke [145].
-
6.
Chronically, aspirin is recommended as initial treatment to prevent recurrent ischemic (not hemorrhagic) stroke [146].
-
7.
In patients with acute coronary syndrome, DAPT or aspirin may continue to reduce CVD risk beyond one year, with the continued recommendation of DAPT or aspirin mostly dependent upon safety (i.e., risk of bleeding) [147].
-
8.
Tobacco cigarette smoking increases CVD risk via promoting thrombosis, inflammation, free radical formation, carbon monoxide-mediated increase in carboxyhemoglobin formation, increase in sympathetic activity (with increased myocardial oxygen demand and potential promotion of dysrhythmias), reduced nitric oxide with endothelial dysfunction, and oxidation of low density lipoprotein cholesterol [148].
-
9.
To reduce the risk of thrombosis, CVD, cancer, and other ill effects of tobacco cigarette smoking [4], patients, families, and caregivers may benefit from an online resource regarding prevention and cessation of cigarette smoking and control of tobacco use [149].
-
10.
The aerosol from vaping e-cigarettes typically does not contain all the contaminants in tobacco smoke. Short-term use of vaping e-cigarettes in health individuals may not adversely affect vascular function [127,150]. However, most e-cigarettes deliver nicotine, which is highly addictive and has many effects that may increase the long-term risk of CVD. While potentially safer from a CVD standpoint compared to tobacco smoking, the Centers for Disease Control (CDC) and Food and Drug Administration recommend that tetrahydrocannabinol (THC)-containing and/or nicotine-containing vaping e-cigarettes never be used by youths and young adults, or women who are pregnant, and not started by adults who do not currently use tobacco products [131]. Those choosing to use e-cigarettes as an alternative to cigarettes should completely switch from cigarettes to e-cigarettes, and not use both products [131]. Adults using nicotine-containing e-cigarette, or vaping, products as an alternative to cigarettes should not go back to tobacco-based cigarette smoking [131]. While much is unknown [151], vaping e-cigarettes may be a reasonable stepwise treatment for tobacco cigarette smokers who have failed smoking cessation, and plan to utilize vaping e-cigarettes as a path towards discontinuing all smoking products [127].
|
