DALLAS – Oct. 28, 2020 – An X-ray test commonly used to assess hardening of the arteries could help doctors decide whether the benefits of taking aspirin to prevent a first heart attack or stroke outweigh the risks of bleeding from its use, UT Southwestern research suggests.

The findings, published online today in JAMA Cardiology, could give doctors and patients more concrete guidelines for making this important decision.

Due to its anti-clotting properties, aspirin is widely prescribed as a preventive measure to patients who have already had cardiovascular events, such as a heart attack or ischemic stroke. However, aspirin’s role in primary prevention – averting first heart attacks and strokes – has been unclear, explains study leader Amit Khera, M.D., professor of internal medicine and director of the Preventive Cardiology Program at UTSW.
After decades of commonly prescribing aspirin for primary prevention, recent guidelines from the American Heart Association (AHA) and American College of Cardiology (ACC) recommend more select use for those with the highest risk of cardiac events due to the increased risk of bleeding.

“We used to say for aspirin, generally yes, occasionally no,” Khera says. “With these new guidelines, we’ve flipped that on its head and are saying that we should not use aspirin for most people in primary prevention.”

However, he adds, it’s been unclear how to select which patients might still benefit most from aspirin therapy, taking into account the risk of bleeding. “We need tools to find that sweet spot where aspirin is most beneficial and offsets the associated risks,” he says.

In the study, Khera and his colleagues looked to a diagnostic test – coronary artery calcium (CAC) scanning – to see if it could help doctors make this important decision. CAC scanning, a CT scan that scores the amount of calcium that lines the heart’s arteries, is commonly performed to detect hardening of the arteries and risk of a heart attack or stroke.

The researchers gathered data from the Dallas Heart Study, an ongoing study that tracks the development of cardiovascular disease in more than 6,000 adults in Dallas County. Initially, participants were invited to three visits for the collection of health and demographic information, laboratory samples, and various imaging studies, including CAC scanning. These volunteers were then followed for 12 years on average to track those who had heart attacks, died from heart disease, or had a nonfatal or fatal stroke – medical problems collectively called atherosclerotic cardiovascular disease – and/or who had a bleeding event that caused hospitalization or death.

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