The aspirin heart disease prevention conundrum.

The use of daily aspirin in a primary prevention population to reduce cardiovascular disease event risk is a conundrum because the reduction in cardiovascular event risk is balanced by an equal increase in the risk of a serious gastrointestinal bleed. This conundrum can be partially clarified by genetic testing for polymorphisms. A genetic polymorphism in the apolipoprotein (a) component of lipoprotein (a) has been identified that could help identify patients who may benefit the most from daily aspirin in regard to coronary heart disease event reduction. Recent clinical trials have demonstrated that carriers of the variant (rs3798220) have a significantly greater risk for a coronary heart disease event compared to non-carriers. However, in carriers of the variant randomized to aspirin, the incidence of major coronary heart disease events was reduced to the same level as subjects who did not have the variant. This provides a clinically available tool that may allow identification of a subset of primary prevention patients who derive more cardiovascular risk reduction from daily aspirin than the risk of a serious gastrointestinal bleed. This provides an inexpensive treatment options for patients with the variant.