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The Value of CAC Scoring & Aspirin in the Prevention of ASCVD

Investigators from The Donald W. Reynolds Cardiovascular Clinical Research Center at University of Texas Southwestern Medical Center recently concluded a study that examined the relationship between CAC scoring, bleeding risk, and 10-year ASCVD risk while exploring the net benefit of Aspirin at three different CAC score categories.

The goal of the study was to identify more ways for patients to practice primary prevention of heart disease.

What is CAC Scoring?

Coronary Artery Calcium (CAC) Scoring is a test that measures the amount of calcium in the walls of the heart’s arteries. A score greater than 100 signifies a higher risk of heart disease while a score of 0 signifies a lower risk. CAC Scoring is primarily used to assess the risk of a patient developing ASCVD.

What is ASCVD?

ASCVD stands for Atherosclerotic Cardiovascular Disease. It is an umbrella term that is used to describe a variety of heart diseases that are caused by plaque buildup in the arterial walls. ASCVD can refer to the following conditions:

  • Coronary heart disease, such as angina and myocardial infarction
  • Cerebrovascular disease, such as ischemic stroke and carotid artery stenosis
  • Peripheral artery disease, such as claudication
  • Aortic atherosclerotic disease, such as abdominal aortic aneurysm

The findings of this study are relevant to the primary prevention of ASCVD. Primary prevention is the effort to delay the onset of ASCVD in patients who do not yet suffer from it while secondary prevention is the effort to treat already existing ASCVD.

When assessing ASCVD risk, patients will be assigned a 10-year risk score that is used to devise a treatment plan.

How is Aspirin Used to Prevent ASCVD?

The relationship between Aspirin therapy and heart disease is well documented. Aspirin thins out platelets in the bloodstream and can help prevent blood clots from forming in the arterial walls. However, Aspirin is not completely benign. It may increase the likelihood of internal bleeding, particularly in the gastrointestinal area. Do not take Aspirin for ASCVD prevention prior to consulting with a doctor.

Study Findings

The study used participants from the Dallas Heart Study (PDF) cohort who did not already suffer from ASCVD and were not taking Aspirin for primary prevention of ASCVD.

The study found that taking a daily Aspirin would provide a net harm to patients who carried a low and intermediate (less than 20%) 10-year ASCVD risk, regardless of CAC scoring. Likewise, the study showed that Aspirin would provide a net benefit to patients with a high (greater than 20%) 10-year ASCVD risk.

When factoring in CAC score, the study found that patients with a high calcium score (greater than 100) could benefit from taking a daily Aspirin; but only in individuals with low bleeding and low-to-intermediate ASCVD risk.

For patients with high bleeding risk, regardless of their 10-year ASCVD risk and CAC score, Aspirin would provide a net harm.

The investigators concluded that a high CAC score can identify which patients may benefit from a daily aspirin from those who may not, as long as those patients carry a low bleeding risk and a borderline or higher (greater than 5%) 10-year ASCVD risk.

How Does This Study Affect You?

At Virginia Cardiovascular Specialists, we place the same emphasis on prevention as we do treatment. This study helps our cardiologists better identify if a patient needs to take a daily Aspirin to prevent ASCVD.

If you are currently taking a daily Aspirin to lower your risk of heart disease without a doctor’s consultation, stop taking Aspirin and schedule an appointment immediately. The Aspirin may be more harmful than it is beneficial.

Published January 25, 2021

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