Aspirin Use for Primary Cardiovascular Prevention During the COVID-19 Pandemic.

To the Editor:

The meta-regression analysis by Nudy et al demonstrates a benefit from aspirin use for primary cardiovascular prevention, corroborating the final report on aspirin in the Physicians’ Health Study. Based on a consensus that “exercise is known to acutely, albeit transiently, increase the relative risk for sudden cardiac death and acute myocardial infarction,” low-dose aspirin has been proposed to mitigate the increasing frequency of such events resulting from coronary atherosclerosis in middle-aged male recreational athletes. Exercise-induced troponin I elevations predict cardiovascular events and higher mortality in a cohort of older long-distance walkers. As a randomized trial of aspirin in runners lacks feasibility because of the low incidence of index events, athletes with ancillary indices of increased risk are most likely to benefit from such use. ,

Aspirin use for primary prevention warrants consideration in other clinical conditions which generate a systemic inflammatory response. The cytokine storm associated with the coronavirus disease 2019 (COVID-19) infection is a case in point, accounting in part for the excess cardiovascular morbidity and mortality observed during prior viral epidemics.8, 9, 10 Manifestations include the correlation of C-reactive protein levels with cardiac troponins and hypercoagulability with elevated concentrations of D-dimer, which findings may be attenuated by aspirin's anti-inflammatory and antithrombotic effects. Improvement in clinical outcomes including decreased mortality with aspirin in hospitalized patients with coronavirus disease 2019 infection justifies a sufficiently powered randomized controlled primary prevention trial. , Pending the availability of such data, why not exploit the cardioprotective benefit of aspirin by enhancing its use for primary cardiovascular prevention during this pandemic?