Aspirin untuk Pencegahan Primer Penyakit Kardiovaskular

Oleh :

dr. Mia Amelia Mutiara Salikim

Penggunaan aspirin dalam pencegahan primer penyakit kardiovaskular masih menjadi perdebatan. Studi terdahulu melaporkan manfaat moderat dalam hal pengurangan kejadian iskemik, utamanya untuk infark miokard dan stroke. Namun, hal ini dibarengi dengan peningkatan risiko perdarahan. Pencegahan primer adalah melakukan intervensi sebelum pasien mengalami penyakit, yaitu dalam hal ini memberi aspirin sebelum pasien menderita penyakit kardiovaskular.[1,2]

Peran Aspirin dalam Penyakit Kardiovaskular

Aspirin merupakan obat antiinflamasi nonsteroid yang bekerja dengan mengikat dan menginhibisi permanen aktivitas enzim cyclooxygenase (COX). COX-1 terlibat dalam agregasi platelet melalui produksi tromboksan (Tx). Sementara itu, COX-2 terlibat dalam regulasi prostaglandin yang bersifat vasodilator dan antiagregasi.

(Konten ini khusus untuk dokter. Registrasi untuk baca selengkapnya)

Referensi

1. Raber I, McCarthy CP, Vaduganathan M, Bhatt DL, Wood DA, Cleland JGF, et al. The rise and fall of aspirin in the primary prevention of cardiovascular disease. Lancet, 2019. 393:2155–67.
2. Angiolillo DJ, Capodanno D. Aspirin for Primary Prevention of Cardiovascular Disease in the 21st Century: A Review of the Evidence. Am J Cardiol. 2021;144 Suppl 1:S15–22.
3. Davis KAS, Bishara D, Perera G, Molokhia M, Rajendran L, Stewart RJ. Benefits and Harms of Statins in People with Dementia: A Systematic Review and Meta-Analysis. J Am Geriatr Soc. 2020;68:650–8.
4. Seidu S, Kunutsor SK, Sesso HD, Gaziano JM, Buring JE, Roncaglioni MC, et al. Aspirin has potential benefits for primary prevention of cardiovascular outcomes in diabetes: updated literature-based and individual participant data meta-analyses of randomized controlled trials. Cardiovasc Diabetol. 2019;18:70.
5. Abdelaziz HK, Saad M, Pothineni NVK, Megaly M, Potluri R, Saleh M, et al. Aspirin for Primary Prevention of Cardiovascular Events. J Am Coll Cardiol. 2019;73:2915–29.
6. ASCEND Study Collaborative Group, Bowman L, Mafham M, Wallendszus K, Stevens W, Buck G, Barton J, Murphy K, Aung T, Haynes R, Cox J, Murawska A, Young A, Lay M, Chen F, Sammons E, Waters E, Adler A, Bodansky J, Farmer A, McPherson R, Neil A, Simpson D, Peto R, Baigent C, Collins R, Parish S, Armitage J. Effects of Aspirin for Primary Prevention in Persons with Diabetes Mellitus. N Engl J Med. 2018 Oct 18;379(16):1529-1539. doi: 10.1056/NEJMoa1804988.
7. McNeil JJ, Nelson MR, Woods RL, Lockery JE, Wolfe R, Reid CM, Kirpach B, Shah RC, Ives DG, Storey E, Ryan J, Tonkin AM, Newman AB, Williamson JD, Margolis KL, Ernst ME, Abhayaratna WP, Stocks N, Fitzgerald SM, Orchard SG, Trevaks RE, Beilin LJ, Donnan GA, Gibbs P, Johnston CI, Radziszewska B, Grimm R, Murray AM; ASPREE Investigator Group. Effect of Aspirin on All-Cause Mortality in the Healthy Elderly. N Engl J Med. 2018 Oct 18;379(16):1519-1528. doi: 10.1056/NEJMoa1803955.
8. Gaziano JM, Brotons C, Coppolecchia R, Cricelli C, Darius H, Gorelick PB, Howard G, Pearson TA, Rothwell PM, Ruilope LM, Tendera M, Tognoni G; ARRIVE Executive Committee. Use of aspirin to reduce risk of initial vascular events in patients at moderate risk of cardiovascular disease (ARRIVE): a randomised, double-blind, placebo-controlled trial. Lancet. 2018 Sep 22;392(10152):1036-1046. doi: 10.1016/S0140-6736(18)31924-X.
9. Gelbenegger G, Postula M, Pecen L, Halvorsen S, Lesiak M, Schoergenhofer C, et al. Aspirin for primary prevention of cardiovascular disease: a meta-analysis with a particular focus on subgroups. BMC Med. 2019;17:198.
10. Aboyans V. Introducing the 2019 ESC Guidelines on Diabetes, Pre-Diabetes, and CVD: A timely document for cardio-diabetology. Eur Heart J. 2019;40:3217–9.
11. American Diabetes Association. 10. Cardiovascular Disease and Risk Management: Standards of Medical Care in Diabetes—2020. Diabetes Care, 2019;43:S111–34.
12. Bittner V. The New 2019 AHA/ACC Guideline on the Primary Prevention of Cardiovascular Disease. Circulation, 2020;142:2402–4.