Use and Safety of Non-Steroidal Inflammatory Drugs and Aspirin

The use of acetylsalicylic acid, better known as aspirin, dates back to the Egyptians in 1534 BC. Aspirin-like compounds are naturally derived from willow tree bark and myr-tle. At the end of the 19th century aspirin was patented by Bayer as the world’s first syn-thetic drug. The recommended use was pain management. In 1968 it was shown that aspirin inhibited human platelet aggregation. Since 1974 it has been recognized that aspirin use is beneficial in the secondary prevention of myocardial infarction and stroke. As cardiovascular (CV) disease is the leading cause of morbidity and mortality in modern Europe and North-America, the use of aspirin has gained enormous popularity. It has been established that long term use of low-dose aspirin (between 75 to 100 mg per day) can reduce the risk of vascular events with 25%, primarily by acting as platelet aggrega-tion inhibitor. Aspirin is mostly recommended for secondary prevention, however is also considered for primary prevention of CV events in high-risk patients, depending on the number of CV risk factors such as age, sex, life-style and comorbidities. Despite clear evidence supporting the preventive effects of aspirin, and despite the growing burden of CV disease worldwide, aspirin is reportedly underutilized in patients who are at high risk of developing CV events. Approximately 9.6% of adults in the UK in 2006 were preva-lent users of aspirin. This percentage was lower in younger subjects and increased with age to 35% of people over the age of 75. In the Netherlands, which counts 16.5 million inhabitants, more than 1.1 million people treated with low-dose aspirin with 8 million aspirin prescriptions in 2010 (Figure 1.1). The annual related costs of aspirin use were 56 million euro’s in the Netherlands also in 2010 (Figure 1.2).

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