This article is a commentary on:
Effect of aspirin in patients with established asymptomatic carotid atherosclerosis: A systematic review and meta-analysis
J. David SpenceA Commentary on
Effect of aspirin in patients with established asymptomatic carotid atherosclerosis: a systematic review and meta-analysis
by Hu X, Hu Y, Sun X, Li Y and Zhu Y (2022) Front. Pharmacol. 13:1041400. doi: 10.3389/fphar.2022.1041400
Introduction
There was a key flaw in the review by Hu et al. (2022), who reported that aspirin did not slow progression of carotid intima-media thickness (IMT) and did not reduce the risk of cardiovascular events in patients with carotid IMT.
Discussion
The authors studied IMT, which is biologically, (Spence, 2015), genetically, (Pollex and Hegele, 2006), and pathologically (Finn et al., 2010) distinct from atherosclerosis (Spence, 2020). The journal Atherosclerosis has established a policy that IMT must not be referred to as “preclinical atherosclerosis”. It should be referred to as “arterial injury” or “arteriopathy”, not “atherosclerosis” (Raggi and Stein, 2020).
IMT is a much weaker predictor of myocardial infarction (Johnsen et al., 2007) or stroke (Mathiesen et al., 2011) than carotid plaque burden, measured as total plaque area (TPA). Indeed, carotid plaque burden is strongly associated with (Sillesen et al., 2012), and as predictive of cardiovascular risk (Baber et al., 2015) as a coronary calcium score. IMT is neither (Sillesen et al., 2012; Baber et al., 2015).
Conclusion
Among patients referred for cardiovascular prevention whose TPA was in the top quartile (>119 mm2), the 5-year risk of stroke, myocardial infarction or vascular death was 19.5%, after adjusting for baseline risk factors (Spence et al., 2002). It is extremely likely that aspirin would reduce cardiovascular risk in such high-risk patients with true atherosclerosis.
Author contributions
The author confirms being the sole contributor of this work and has approved it for publication.
Conflict of interest
JDS receives small royalties on a patent on 3D ultrasound measurement of atherosclerosis. He is an unpaid officer of a dormant company, Vascularis Inc.
Publisher’s note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
References
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Keywords: aspirin, atherosclerosis, carotid, intima and media thickness, antiplatelet agents, cardiovascular risk
Citation: Spence JD (2023) Commentary: Effect of aspirin in patients with established asymptomatic carotid atherosclerosis: a systematic review and meta-analysis. Front. Pharmacol. 14:1142248. doi: 10.3389/fphar.2023.1142248
Received: 30 January 2023; Accepted: 02 June 2023;
Published: 29 June 2023.
Edited by:
Bert B. Little, University of Louisville, United StatesReviewed by:
Aleksey M. Chaulin, Samara State Medical University, RussiaCopyright © 2023 Spence. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: J. David Spence, dspence@robarts.ca