New “Aspirin-Guide” Mobile App for Clinicians Helps Personalize Decisions About Aspirin Use for Primary Prevention of Cardiovascular Disease 

Low-dose aspirin is recommended by clinicians as a preventive measure for patients who have already had a heart attack or stroke, but the risk of taking low-dose aspirin to prevent or delay a first heart attack or stroke is less clear, as the benefit for reducing the risk of cardiovascular disease (CVD) must be balanced with the increased risk of gastrointestinal or other bleeding. To help clinicians and patients make informed decisions about aspirin use, researchers at Brigham and Women’s Hospital have developed a new, free, mobile app, “Aspirin-Guide,” which calculates both the CVD risk score and the bleeding risk score for an individual patient. In addition, it helps clinicians decide which patients are appropriate candidates for the use of low-dose aspirin (75 to 81 mg daily).

“We developed the Aspirin-Guide app because we realized that weighing the risks and benefits of aspirin for individuals who have not had a heart attack or stroke is a complex process. The new mobile app enables individualized benefit to risk assessment in a matter of seconds while the patient is with the physician,” said Samia Mora, MD, a cardiologist at BWH.

In a commentary published in JAMA in the June 20 issue, and a review in JAMA Internal Medicine published on the same day, co-authors Mora and JoAnn Manson, MD, cardiovascular epidemiologist and Chief of Preventive Medicine at BWH, reviewed the evidence behind the use of aspirin to delay or prevent a first heart attack of stroke and gaveexamples of how the mobile app can help patients and clinicians:

• calculates a 10-year cardiovascular disease risk score (heart disease and stroke) for the patient
• calculates a bleeding risk score based on the patient’s individual risk factors
• uses evidence from the literature, together with the above scores, to compare the number needed to treat vs. the number needed to harm
• helps clinicians to implement current clinical guidelines for low-dose aspirin in primary prevention
• provides the ability to email a summary of the decision-making process to the patient and/or to the clinician for the patient’s record

“Aspirin-Guide is a user-friendly clinical decision support tool that will facilitate informed and personalized decision-making about the use of aspirin in primary prevention of CVD.  Patients should discuss the pros and cons of aspirin treatment with their health care provider,” Manson said.

The free Aspirin-Guide mobile app, developed for iPhones and iPads with the assistance of computer programmer, Jeffrey Ames, is available at the Apple App Store.

Manson and Mora receive support from the National Institutes of Health through grant numbers HL034594, HL117861, CA138962, HHSN268201100001C.

A Nanoparticle Approach to Treating Type 1 Diabetes

Francisco Quintana, PhD, associate scientist at the Brigham’s Ann Romney Center for Neurologic Diseases and associate professor of neurology at Harvard Medical School, along with graduate student, Ada Yeste, and colleagues recently had their paper on tolerogenic nanoparticles and their inhibition of T cell-driven autoimmunity published in Science Signaling. Type 1 diabetes is caused by an autoimmune response that destroys the body’s source of insulin: beta cells in the pancreas. This autoimmune response results from deficits in regulatory T cells (Tregs) that limit pathogenic inflammation. In previous studies on diabetes, cell-based methods have been developed that increase both the number and functionality of the Tregs, but none have worked past the pre-clinical stages. Additionally, previous research was limited to creating Tregs that suppressed general immune responses as opposed to specific ones. The main goal of the team’s research was to induce antigen-specific Tregs able to prevent type 1 diabetes directly without targeting other antigens.

The researchers’ experiments were conducted using non-obese diabetic mice, which were periodically administered nanoparticles to co-deliver a tolerogenic molecule and insulin and induce immune tolerance. Treatment with these nanoparticles suppressed the spontaneous development of type 1 diabetes and significantly inhibited the autoimmune response that destroys beta cells.

“We did some pilot experiments using human T-cells isolated from type 1 diabetes patients and our nanoparticles gave positive results,” Quintana said in a recent interview on the Science Signaling podcast. “The approach we are using is pretty modular in the sense that you can have the same nanoparticle, with the same or similar tolerogenic molecules, and then just change the antigen you use as a way of inducing tolerance to different target organs. The idea is that this approach could be extended to control the autoimmune response in other immune-related diseases.”

Paper cited: Yeste, A. et al. “Tolerogenic nanoparticles inhibit T-cell autoimmunity via SOCS2,” Science Signaling. DOI: 10.1126/scisignal.aad0612