Letter to the Editor
To the Editors:
The recommendations on aspirin use for the primary prevention of cardiovascular events,1 based on cardiovascular risk (CVR) calculation according to the Framingham scale, have recently been published.2 Despite the growing interest in CVR among HIV-infected patients,3,4 the use of aspirin in these subjects has received scant attention to date. However, the gradual aging of these patients means that we are reaching a point where aspirin for primary prevention may be indicated according to the above-mentioned recommendations. We have reviewed the indication of aspirin in a group of HIV-infected patients based on the criteria of these recommendations, with calculation of CVR using the Framingham tables.
A total of 120 consecutive HIV-infected adults were included in a cross-sectional observational study. Demographic data were recorded, along with information on smoking or diabetes, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and blood glucose. Blood pressure was recorded after the consensus recommendations, with confirmation of the new diagnoses based on Holter blood pressure monitoring to rule out white-coat hypertension. The Framingham tables were used to calculate CVR. The indication of aspirin was based on the published criteria for males >45 years of age and females >55 years of age. Calculation was also made of the variation in percentage indication over the coming years as the patients gradually exceed this age limit without changes in the risk factors. In our experience, primary prevention with aspirin would be indicated in 30.8% of the patients, according to the assessment of the Framingham study, yet only 2 patients were taking the medication. Among the males, the percentage would reach 40%. Without modification of the CVR factors, over the next 5 years the indication would be expanded to another 15% as a result of the aging of the group.
Therefore, application of the recently published recommendations on the use of aspirin in HIV-infected patients could help reduce the rise in cardiovascular events described in some studies. Aspirin would be indicated in a large proportion of patients, particularly in males, and this indication moreover may be expected to increase over the coming years.
In the management of CVR among HIV-infected patients, it is therefore necessary to also consider aspirin as primary prevention treatment.
Carlos Tornero, PhD
Ana Ventura, PhD
Maricarmen Mafe, PhD
Department of Internal Medicine, Hospital Gandia, Spain
1. US preventive Services Task Force. Aspirin for the prevention of cardiovascular disease: US preventive services task force recommendation statement. Ann Intern Med
2. Wilson PW, D'Agostino RB, Levy D, et al. Prediction of coronary heart disease using risk factor categories. Circulation
3. Friis-Moller N, Sabin CA, Weber R, et al. Combination antiretroviral therapy and the risk of myocardial infarction. N Engl J Med
4. D:A:D Study group. Class of antiretroviral drugs and the risk of myocardial infarction in HIV infected patients. N Engl J Med
. 2007;356:1723- 1735.