EMERGING EVIDENCE THAT MAKES A BIG DIFFERENCE

ESC, 2023

European Society of Cardiology

ESC 2023, Guidelines on cardiovascular disease prevention in clinical practice

ASPIRIN as a primary prevention strategy1

In adults with T2DM without a history of symptomatic ASCVD or revascularization, Aspirin (75– 100 mg o.d.) may be considered to prevent the first severe vascular event, in the absence of clear contraindications (class IIb).

Secondary prevention strategy1

Adding very low-dose rivaroxaban to low-dose Aspirin for long-term prevention of serious vascular events should be considered in patients with diabetes and CCS or symptomatic PAD without high bleeding risk.(class IIa).

Think secondary prevention

ESC: European Society of Cardiology; DM: diabetes mellitus; CVD: cardiovascular disease; P2Y12: platelet adenosine diphosphate P2Y12 receptor; ACS: acute coronary syndrome; DAPT: dual antiplatelet therapy; CCS: chronic coronary syndrome. cClopidogrel is recommended for 12 months DAPT if prasugrel and ticagrelor are not available, cannot be tolerated, or are contraindicated, and may be considered in older ACS patients.

Reference

  1. Marx N, Federici M, Schütt K, Müller-Wieland D, Ajjan RA, Antunes MJ, Christodorescu RM, Crawford C, Di Angelantonio E, Eliasson B, Espinola-Klein C, Fauchier L, Halle M, Herrington WG, Kautzky-Willer A, Lambrinou E, Lesiak M, Lettino M, McGuire DK, Mullens W, Rocca B, Sattar N; ESC Scientific Document Group. 2023 ESC Guidelines for the management of cardiovascular disease in patients with diabetes. Eur Heart J. 2023 Oct 14;44(39):4043-4140. doi: 10.1093/eurheartj/ehad192. Erratum in: Eur Heart J. 2023 Dec 21;44(48):5060. doi: 10.1093/eurheartj/ehad774. Erratum in: Eur Heart J. 2024 Feb 16;45(7):518. doi: 10.1093/eurheartj/ehad857. PMID: 37622663.
  2. Byrne RA, Rossello X, Coughlan JJ, Barbato E, Berry C, Chieffo A, Claeys MJ, Dan GA, Dweck MR, Galbraith M, Gilard M. 2023 ESC guidelines for the management of acute coronary syndromes: developed by the task force on the management of acute coronary syndromes of the European Society of Cardiology (ESC). European Heart Journal: Acute Cardiovascular Care. 2024 Jan;13(1):55-161.