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VOLUME 9 NUMBER 1 • MARCH 2012
27
SA JOURNAL OF DIABETES & VASCULAR DISEASE
EVIDENCE IN PRACTICE
Carefully manage discontinuation of low-dose aspirin
T
he risk of non-fatal myocardial infarction
(MI) or death from coronary heart disease
increases by nearly 50% in patients with a
history of ischaemic events who discontinue
low-dose aspirin therapy in primary care.
Although low-dose aspirin is standard
treatment for the secondary prevention of
cardiovascular disease, up to half of long-
term users stop therapy. Discontinuation has
been linked with increased risk of ischaemic
events and death in secondary care. This
study evaluated the risks in primary care.
Data from the Health Improvement
Network database of > 3 million patients
in primary care in the UK identified 39 513
people aged 50–84 with prescriptions
for aspirin for secondary prevention of
cardiovascular outcomes. They were
followed for an average of 3.2 years
to identify any cases of non-fatal MI or
death from coronary heart disease.
Of these patients, 876 experienced
MI and 346 died from coronary heart
disease. Compared with current users,
people who had recently stopped taking
SAJDVD recommended action
Low-dose aspirin prophylaxis plays a vital role
in secondary prevention of cardiovascular dis-
ease. This primary care study supports the results
of previous studies in secondary care. Primary
healthcare professionals should encourage
patients with a history of cardiovascular events to
continue with their long-term aspirin prophylaxis.
Efforts to improve adherence with therapy should
be ongoing.
Reference
Garcia Rodriguez L, Cea-Soriano L, Martin-Me-
rino E, Johansson S. Discontinuation of low dose
aspirin and risk of myocardial infarction: case-
control study in UK primary care.
BMJ
2011;
343
:
doi:10.1136/bmj.d4094
http: / /www.ncbi .nlm.nih.gov/pmc/art icles/
PMC3139911/?tool=pubmed
were about four more cases of non-fatal MI
among patients who discontinued treatment
with low-dose aspirin (recent discontinuers)
compared with patients who continued
treatment.
Originally from
PCCJ
2011;
4
(4): 143.
aspirin had a significantly increased risk of
non-fatal MI or death from coronary heart
disease combined [rate ratio (RR) 1.43, 95%
CI: 1.12–1.84) and non-fatal MI alone (RR
1.63, 95% CI: 1.23–2.14]. There was no
significant association between recently
stopping low-dose aspirin and the risk of
death from coronary heart disease (RR
1.07, 95% CI: 0.67–1.69). For every 1 000
patients, over a period of one year there
15-minute daily exercise significantly improves health
E
ven limited exercise of about 15 minutes per day results in a
reduced risk of all-cause mortality of 14% and life expectancy
was extended by three years. Previously the health benefits
of leisure-time physical activity have been well known, but it
was unclear whether less exercise than the recommended 150
minutes per week (30 minutes x 5) would be beneficial.
In a study of over 400 000 people in Taiwan with an average
follow-up of eight
years,
participants
were divided into five
categories of exercise
volume: inactive, or
low, medium, high,
or very high activity.
Hazard ratios (HR) for
mortality risks and
life expectancy were
calculated for each
group compared with
the inactive group.
Compared with
individuals in the
inactive group, those
in the low-volume
activity group (an
average of 92 min-
SAJDVD recommended action
These data provide primary care professionals with strong encouragement
for convincing their patients that even small amounts of physical activity
can bring significant health benefits, including a substantial reduction in
mortality.
Reference
Wen C-P, Wai J, Tsai M,
et al
. Minimum amount of physical activity for
reduced mortality and extended life expectancy: a prospective cohort study.
Lancet
2011, DOI:10.1016/S0140-6736(11)60749-6.
utes exercise per week/about 15 minutes a day) had a 14%
reduction in risk of all-cause mortality, a 10% reduced risk of all-
cancer mortality, and a three-year longer life expectancy.
Every additional 15 minutes of daily exercise beyond the
minimum amount of 15 minutes a day further reduced all-cause
mortality by 4% and all-cancer mortality by 1% (0.3–4.5). These
benefits were applicable to all age groups and both genders, and
to those with cardiovascular disease risk factors. Individuals who
were inactive had a 17% increased risk of mortality compared
with individuals in the low-volume activity group.
The authors commented: ‘This low-volume of physical activity
could play a central part in the war against non-communicable
diseases, reducing medical costs and health disparities.’
Originally from
PCCJ
2011;
4
(4): 145.