New Issues in the Screening and Prevention of Cardiovascular Disease

  • Brian V. Reamy

Aspirin Prophylaxis

The prevention of cardiovascular disease is optimized by blood pressure control, weight management, and tobacco cessation in addition to the reduction of elevated serum lipids. Even greater risk reduction can be obtained in some patients by the use of aspirin to prevent cardiovascular morbidity and mortality.

The United States Preventive Services Task Force strongly recommends that clinicians discuss the benefits of aspirin for the prevention of cardiovascular disease with their patients. It gave chemoprophylaxis with aspirin an “A” rating for patients with a greater than 3% 5-year risk of having a cardiovascular event [1]. It is important to note that the Framingham criteria computes 10-year risk, so it must be multiplied by 0.5 to get the 5-year risk.

As a general rule-of-thumb, most 40-year-old men and 50-year-old women will benefit from aspirin therapy. An important gender-specific clarification of this benefit was noted in 2006. Men have reduced cardiovascular...


Coronary Calcium Score Electron Beam Compute Tomography Risk Factor Assessment Clinical Outcome Study Future Coronary Event 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Recommendations of the U.S. Preventive Services Task Force: The Guide to Clinical Preventive Services, 2005. AHRQ Pub. 05-0570, pp 55–59.Google Scholar
  2. 2.
    Berger JS, Roncaglioni MC, Avanzini F, et al. Aspirin for the primary prevention of cardiovascular events in women and men. JAMA 2006;295:306–313.PubMedCrossRefGoogle Scholar
  3. 3.
    American Heart Association. Primary Prevention in the Adult. 2003. Available at Accessed on December 18, 2006.
  4. 4.
    Meyerburg RJ, Interian A Jr, Mitrani RM, et al. Frequency of sudden cardiac death and profiles of risk. Am J Cardiol 1997;80:10F–19F.CrossRefGoogle Scholar
  5. 5.
    Ridker PM. High sensitivity C-reactive protein and cardiovascular risk: rationale for screening and primary prevention. Am J Cardiol 2003;92:17 K–22 K.CrossRefGoogle Scholar
  6. 6.
    Pearson TA, Mensah GA, Alexander RW, et al. Markers of inflammation and cardiovascular disease: a statement from the Centers for Disease Control and Prevention and the American Heart Association. Circulation 2003;107:499–511.PubMedCrossRefGoogle Scholar
  7. 7.
    Ridker PM, Cannon CP, Morrow D, et al. C-reactive protein levels and outcomes after statin therapy. N Engl J Med 2005;352: 20-28.PubMedCrossRefGoogle Scholar
  8. 8.
    Pischon T, Girman CJ, Sacks FM, et al. Non-high density lipoprotein cholesterol and apolipoprotein B in the prediction of coronary heart disease in men. Circulation 2005;112:3375–3383.PubMedCrossRefGoogle Scholar
  9. 9.
    Danik JS, Rifai N, Buring JE, Ridker PM. Lipoprotein a measured with an assay independent of apolipoprotein a isoform size and risk of future cardiovascular events among initially healthy women. JAMA 2006;296:1363–1370.CrossRefGoogle Scholar
  10. 10.
    Ariyo AA, Thach C, Tracy R. Lp(a) lipoprotein, vascular disease, and mortality in the elderly. N Engl J Med 2003;349:2108–2115.PubMedCrossRefGoogle Scholar
  11. 11.
    Koenig W, Khuseyinova N, Lowel H, et al. Lipoprotein-associated phospholipase A2 adds to risk prediction of incident coronary events by C-reactive protein in apparently healthy middle-aged men from the general population. Circulation 2004;110:1903–1908.PubMedCrossRefGoogle Scholar
  12. 12.
    Wang TJ, Gona P, Larson MG, et al. Multiple biomarkers for the prediction of first major cardiovascular events and death. N Engl J Med 2006;355:2631–2639.PubMedCrossRefGoogle Scholar
  13. 13.
    Thompson GR, Partridge J. Coronary Calcification Score: the coronary risk impact factor. Lancet 2004;363:557–559.PubMedCrossRefGoogle Scholar
  14. 14.
    ACCF/AHA Writing Committee. ACCF/AHA 2007 clinical expert consensus document on coronary artery calcium scoring by computed tomography in global cardiovascular risk assessment and in evaluation of patients with chest pain. Circulation 2007;115:402–426.Google Scholar
  15. 15.
    Raggi P, Davidson M, Callister TQ, et al. Aggressive versus moderate lipid-lowering therapy in hypercholesterolemic postmenopausal women. Circulation 2005;112:563–571.PubMedCrossRefGoogle Scholar
  16. 16.
    Tardiff JC, Heinonen T, Orloff D, Libby P. Vascular biomarkers and surrogates in cardiovascular disease. Circulation 2006;113:2936–2942.CrossRefGoogle Scholar
  17. 17.
    Lorenz MW, Markus HS, Bots ML, et al. Prediction of clinical cardiovascular events with carotid intima-media thickness: a systematic review and meta-analysis. Circulation 2007;115:459–467.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  1. 1.Chair and Associate Professor, Department of Family Medicine, Uniformed ServicesUniversity of the Health SciencesBethesda

Personalised recommendations