India’s Cardiometabolic Risk Landscape
Prevalence of Overweight and Obesity
India is experiencing a significant shift in its cardiometabolic risk profile, with overweight and obesity affecting 23.5% and 6.7% of adults, respectively. This increase is accompanied by rising rates of hypertension, diabetes, and dyslipidemia.
Central Obesity and Gender Disparities
Central obesity is particularly concerning, impacting 40% of women compared to only 12% of men. This statistic highlights the unique prevalence of visceral adiposity among the Indian population.
Influence of Lifestyle Changes
Concurrently, changes in dietary habits, widespread tobacco use (28.6%, mainly in rural areas), and increasing lifestyle stressors are critical factors. A recent survey indicated that more than half of young adults in India spend 1 to 3 hours daily on social media, with 31% of respondents reporting stress. These elements contribute to metabolic dysfunction, platelet hyperreactivity, and endothelial injury.
Need for Early Interventions
The convergence of these risk factors underscores the importance of early antiplatelet strategies, such as aspirin, for mitigating atherothrombotic risks when appropriately indicated.
Potential Role of Aspirin in Lifestyle-Mediated Atherothrombosis
Impact of Lifestyle Factors
Lifestyle choices, including tobacco use, psychosocial stress, and adverse dietary changes, lead to chronic low-grade inflammation. This inflammation enhances platelet activation by upregulating COX-1/thromboxane A₂ (TXA₂) biosynthesis, creating a prothrombotic state where platelet hyperreactivity continues despite optimal lipid and glycemic control.
Importance of COX-1 Inhibition
This condition highlights the critical role of aspirin’s COX-1 inhibition in the management of atherothrombotic risk.
Aspirin in Cardiovascular Event Prevention
Clinical Evidence for Aspirin Use
Recent updates from the AHA 2025 Congress in New Orleans provided compelling insights into the use of aspirin for high-risk primary prevention. A propensity analysis involving 11,681 patients from an electronic health records (EHR) primary prevention registry across a large healthcare network (over 400 sites) was conducted over a span of 10 years, where 88.6% of participants used aspirin.
Findings on Aspirin Efficacy
The results demonstrated that moderate-to-high frequency aspirin use (≥30% adherence) led to a 42-58% reduction in myocardial infarction (MI) and revascularization events, a 43-57% reduction in ischemic stroke, and high-frequency use (≥70% adherence) resulted in a 47% reduction in all-cause mortality (HR 0.53, p<0.001).