Thousands of delegates* converge annually in glittering convention centers on a regular basis to present high quality research. It’s all about overflowing seminar halls, stunning speeches , Intense questions , adoring debates , cozy discussions in grand dinner nights . The meet continues further, as news breaks in global TV shows, spreads in non-stop handles of twitter after igniting the face books.
Finally , it ends over the week-end ! (It has to you know ! ) . . . Every one flies back, only to come back next year to ponder “almost the same issue” all over again. (Some times the questions are left unanswered for decades ! Not getting an answer is okay , after all research is a journey towards truth but sustaining a confusion or creating new one has been a norm in recent times.)
*Sorry , If am provocative , I need to be genuine in my expression.
Coming to the topic, Aspirin is one wonder drug which made a big impact on CAD risk . We know there is something great with this cheapest and humble Dual COX blocker.The only weak point is ,it lacks the glamor quotient like that of newer antiplatelets, NOACs and their clones.
Its my perception ,big breaking research has tried to ditch this drug for quiet a while .But ,it was all too difficult to go for the kill.So these studies circumnavigate the real issue. and end up with suspicious conclusions (or Inconclusions !) always trying to hide behind sinister statistics of course with a questionable caveat !
What’s new in the topic of Primary prevention of CAD ?
Two major studies were released recently in August 2018
Both studies suggest caution for Aspirin. If Aspirin is really bad it would (and should) have buried long ago. We should be thankful even in these testing times for truth ,this humble drug is fighting back and forth .(Digoxin is another close cousin of Aspirin fighting for the existence crisis in cardiology ! )
So what is the role of Aspirin in primary prevention of CAD ?
This question doesn’t make sense in many clinical situations.
Primary and secondary prevention are defined with reference to manifest vascular event. We will not know how much of silent CAD exist in asymptomatic persons.Primary prevention of CAD itself could be a misnomer as most elderly do carry at-least some form of CVD. For example, If a patient with manifest peripheral arterial disease (PAD) and takes Aspirin , its secondary prevention for PAD but becomes primary prevention for CAD . . . isn’t ?
Final message
We know Aspirin continues to be the flag bearer of all DAPT regimen.I wish it remains a star in primary prevention as well. It looks like(for me) these studies are another attempt to pull down Aspirin in primary prevention .I think ARRIVE failed to reach the desired conclusion. Aspirin is a warrior and it will never allow that to happen and ASCEND to glory again !
Postamble
Modern drug research appears to pursue a study till the desired conclusion is reached. We need important drugs in many vital areas of cardiology .Our energy should be focused to find new molecules. It is worrying trend(if its true !) if efforts are wasted to finish off humble generic drugs with proven worthiness. Doing research in established concepts is the most silly thing to do. Its duplication of knowledge.
Counterpoint
It’s scientific blasphemy to criticise studies without analysing it in a professional manner.It appears all too brutal to take a biased view and questioning the motive of researchers. Yes agreed , I may be prejudiced , . . but , why a doctor of this caliber make a statement of this sort ?
Its a fact , there are so many true scientist doing their job right, my query is simple why we are not getting clear answer in many common issues In spite of great research ?
Is it the limitation of science or vagaries of research ? I think it’s more of a Intellectual insufficiency aided by malfunctioning regulators !
Dr.S.Venkatesan MD 