Also, people who have had a heart attack are more likely to have another heart attack if they have a high hs-CRP level. Sahin, U., Karik, K. & Treci, . mRNA-based therapeuticsdeveloping a new class of drugs. The RBD-binding antibody concentrations and SARS-COV-2 neutralizing titres elicited by two doses of BNT162b1 appear to follow this pattern, showing a decline on day 43. The two participants immunized with 1g BNT162b1 who lacked a CD4+ response had no detectable virus-neutralizing titres (VNT50) (Extended Data Fig. If you find something abusive or that does not comply with our terms or guidelines please flag it as inappropriate. Lab. The higher the CRP levels, the greater amount of inflammation in the body. Sign up for the Nature Briefing: Translational Research newsletter top stories in biotechnology, drug discovery and pharma. While it's uncertain how much reducing CRP itself can help, elevated levels are a sign that you likely have other risk factors that need to be addressed with aggressive measures. Med. Modification of antigen-encoding RNA increases stability, translational efficacy, and T-cell stimulatory capacity of dendritic cells. The blood tests are almost normal now (3 months later). This content does not have an English version. Individuals immunized with a single dose of 60g had a lower response rate (4/9; 44%) and a weaker CD8+ T cell response to RBD. b, RBD-specific CD4+ T cells producing the indicated cytokine as a percentage of total cytokine-producing RBD-specific CD4+ T cells. Both CRP levels and lymphocyte counts are considered pharmacodynamics markers for the mode-of-action of RNA vaccines. Elsevier; 2023. https://www.clinicalkey.com. Ferri FF. She does not take any medications. Afterwards, samples were fixed and permeabilized using the Cytofix/Cytoperm kit according to the manufacturers instructions (BD Biosciences). The interferon gamma gene polymorphism +874 A/T is associated with severe acute respiratory syndrome. 2a) with CD4+ T cell responses (as in Fig. 1. Ther. RBD-specific CD4+ T cells secreted IFN, IL-2, or both, but in most individuals they did not secrete IL-4 (Fig. PMID: 32998157. https://pubmed.ncbi.nlm.nih.gov/32998157/, Potempa LA, Rajab IM, Hart PC, Bordon J, Fernandez-Botran R. Insights into the Use of C-Reactive Protein as a Diagnostic Index of Disease Severity in COVID-19 Infections. Am J Trop Med Hyg. https://www.mayocliniclabs.com/test-catalog/Clinical+and+Interpretive/82047. health information, we will treat all of that information as protected health The American College of Cardiology and American Heart Association consider a level of 2 mg/L and above to be a possible risk factor for heart attacks. HEK293T cells (ATCC CRL-3216) were seeded (culture medium: DMEM high glucose (Life Technologies) supplemented with 10% heat-inactivated FBS (Life Technologies), 90.1 units/ml penicillin, 90.1 g/ml streptomycin and 0.26mg/ml l-glutamine (Life Technologies)) and transfected the following day with spike expression plasmid using Lipofectamine LTX (Life Technologies) following the manufacturers protocol. All of the clinical studies consistently described a slight and short-lived increase in inflammatory mediators in blood following vaccination, in particular, an increase in CRP and IL-6. PMID: 32588812; PMCID: PMC7410479. You also may wish to reduce stress and anxiety. Nature 543, 248251 (2017). have securities from Regeneron Pharmaceuticals, Inc; C.F.-G. and P.-Y.S. An Infectious cDNA Clone of SARS-CoV-2. Should she avoid the second dose? Methods: Data for COVID-19 patients with clinical outcome in a designated hospital in Wuhan, China, were retrospectively collected and analyzed from 30 January 2020 to 20 February 2020. Extended Data Fig. Stock, C. Mller, S. Murphy, G. Szab and M. Vehreschild for technical support, project management and advice; A. Finlayson and M. Rao for editorial assistance; P. Koch and F. Groher for data management and analysis; S. Liebscher and O. Kistner for expert advice; J. Absalon for manuscript advice; the CRS Team (Mannheim and Berlin) for study conduct: S. Baumann, M. Berse, M. Casjens, B. Ehrlich, and F. Seitz; the Pfizer Vaccines Clinical Assays Team and the Pfizer Aviation Team for technical and logistical support of serology analyses; and the GISAID Nucleotide database for sharing of SARS-CoV-2 complete genome sequences. and T.P. No serious adverse events were reported. Methods 315, 121132 (2006). received compensation from Pfizer to perform the neutralization assay; no other relationships or activities that could appear to have influenced the submitted work. Another constraint is that we did not perform further T cell analysis (for example, deconvolution of epitope diversity, characterization of HLA restriction, T cell phenotyping and TCR repertoire analysis) before and after vaccination, because of the limited blood volumes that were available for biomarker analyses. The second dose was fine. d, Cytokine release by PBMCs from the 50g cohort (n=5; assay results from remaining samples of this and other cohorts not available at the time). Increased serum amyloid A (SAA) APR predicted severe vascular disease. Avoid processed meat, consume omega-3 fatty acids or monounsaturated fatty acids, and include more fresh fruits and vegetables. Ther. Aspirin therapy isn't for everyone. A multisystem inflammatory syndrome in children (MIS-C) and adults (MIS-A) occurring after coronavirus disease (COVID-19) has been identified; onset is 4-6 weeks after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection ( 1 - 3 ). RBD-binding immunoglobulin G (IgG) concentrations and SARS-CoV-2 neutralising titres in sera increased with dose level and after the second dose. Accessed Nov. 18, 2022. Pre-dose responses across all dose levels were combined. Electrocardiogram (ECG) showed diffuse ST-segment elevation suggestive of pericarditis. What It Means to Have High C-Reactive Protein Levels. Muruato, A. E. et al. In the 30-g dose level cohort, 2 out of 12 (16.7%) subjects experienced severe local reactogenicity; 6 out of 12 (50%) subjects reported severe systemic reactogenicity (primarily headache, chills, fatigue or muscle pain); and 1 subject out of 12 (8.3%) reported fever. Although the magnitude of the response varied between individuals, participants with the strongest CD4+ T cell responses to RBD had more than tenfold the memory responses observed in the same participants when stimulated with cytomegalovirus (CMV), Epstein Barr virus (EBV), influenza virus and tetanus toxoid-derived immuno-dominant peptide panels (Fig. Heat-inactivated participant sera were diluted to 1:500, 1:5,000, and 1:50,000. Negative values were set to zero. The CRP produced in the liver is a response to the activity of white blood cells that fight infection and inflammation in the body. J. Occup. Checked bars indicate that no boost vaccination was performed. The Link Between Triglycerides and Heart Health, Benefits of Fish Oil for Heart Disease Prevention, 2019 ACC/AHA Guideline on the primary prevention of cardiovascular disease: Executive summary: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, Cardiovascular disease: Risk assessment with nontraditional risk factors, No Significant Association Between Plasma Endosialin Levels and the Presence or Severity of Coronary Artery Disease, nflammation and cardiovascular disease: From mechanisms to therapeutics, Anxiety disorders and inflammation in a large adult cohort, Statin therapy decreases serum levels of high-sensitivity C-reactive protein and tumor necrosis factor- in HIV-infected patients treated with ritonavir-boosted protease inhibitors, C-reactive protein and clinical outcomes in patients with COVID-19. Preprint at https://www.medrxiv.org/content/10.1101/2020.08.17.20176651v2 (2020). However, they could not be used for differential diagnosis, since both viral and bacterial infections induce the upregulation of crp expression in fish [68,72,104,105]. Verywell Health's content is for informational and educational purposes only. A CRP test is sometimes also used to predict the progression of COVID-19. It may be due to serious infection, injury or chronic disease. Chong, W. P. et al. Sera were obtained from Sanguine Biosciences (Sherman Oaks, CA), the MT Group (Van Nuys, CA) and Pfizer Occupational Health and Wellness (Pearl River, NY). To address this concern, we conducted neutralization assays with 17 pseudotyped viruses, 16 of which enter cells using a spike with a different RBD variant found in circulating strains and one of which uses the dominant spike variant D614G. An elevated level of CRP is considered an increased risk for heart disease, and testing CRP levels is often part of cardiac care. IFN is a key cytokine for several antiviral responses. PBMCs thawed and rested for 4h in OpTmizer medium supplemented with 2 g/ml DNase I (Roche) were restimulated with a peptide pool representing the vaccine-encoded SARS-CoV-2 RBD (2 g/ml/peptide; JPT Peptide Technologies) in the presence of GolgiPlug (BD) for 18 h at 37C. COVID-19 vaccine BNT162b1 elicits human antibody and TH1 T cell responses. CRP is an inflammatory serum protein that has previously been described as biomarker for various infectious disease vaccines and an indicator of vaccine adjuvant activity16,17,18,19. She was not exposed to any antibiotics or other medications in this spring. PBMCs were obtained on day 1 (pre-prime) and 293 (post-boost). In summary, these findings indicate that BNT162b1 induces functional and proinflammatory CD4+ and CD8+ T cell responses in almost all participants, with TH1 polarization of the helper response. K.K. Alfaddagh A, Martin SS, Leucker TM, Michos ED, Blaha MJ, Lowenstein CJ, et al. Human SARS-CoV-2 infection/COVID-19 convalescent PBMC samples (n=15) were collected from donors 2279 years of age 3062 days after PCR-confirmed diagnosis when donors were asymptomatic. The mean fraction of RBD-specific T cells within total circulating T cells obtained by BNT162b1 vaccination was substantially higher than that observed in fifteen donors who had recovered from COVID-19. Thank you, {{form.email}}, for signing up. Looking for the very latest from Dr. Weil on a variety of topics, including healthy living, longevity, well-being, recipes, and healthy diets as well as photos of his daily life, garden, and wellness travels? Immune sera broadly neutralized pseudoviruses with diverse SARS-CoV-2 spike variants. Although there were no relevant changes in routine clinical laboratory values after vaccination with BNT162b1, vaccinated participants showed a transient increase in C-reactive protein (CRP) and a temporary reduction in blood lymphocyte counts, both of which were dose-dependent (Extended Data Fig. This site uses cookies. The detection of IFN, IL-2 and IL-12p70, but not IL-4 or IL-5, indicates a favourable TH1 profile and the absence of a potentially deleterious TH2 immune response. CAS Each serum was tested in duplicate and GMT plotted. Livedo reticularis occurs when there is increased visibility of the venous plexus, often caused by reduced arterial inflow or venodilation.1 Although livedo reticularis has been reported in patients with COVID-19,2,3 it has also been reported following COVID-19 vaccination.4 An 80-year-old woman presented with eruption. 2021;42(23):2270-2279. doi:10.1093/eurheartj/ehaa1103. Vogelzangs N, Beekman AT, de Jonge P, Penninx BW. This is true even for those with elevated CRP levels who have no obvious symptoms or signs of active inflammation. C-reactive protein and risk of ovarian cancer: A systematic review and meta-analysis, Between 0.3 mg/dL and 1.0 mg/dL, considered mildly elevated, Between 1 mg/dL and 10 mg/dL, considered moderately elevated, Above 10 mg/dL, considered to be highly elevated, Increasing your aerobic exercise (e.g, running, fast walking, cycling). The next evening, she developed a fever (39C). The antigen-encoding RNA contains sequence elements that increase RNA stability and translation efficiency in human dendritic cells13,14. You can also find him on Instagram and Twitter. BMC Infect. Incorporation of pseudouridine into mRNA yields superior nonimmunogenic vector with increased translational capacity and biological stability. The CRP test can help identify a wide array of medical conditions, including: Some studies have identified a relationship between high CRP levels and fatigue. Her primary care provider noted leukocytosis to 20 K/uL and referred her to the ED. Blood 108, 32533261 (2006). She happened to do her annual blood tests 3 days before her COVID-19 shot. You don't necessarily need medicine to lower your levels of CRP. The RNA is optimized for high stability and translation efficiency13,14 and incorporates 1-methylpseudouridine instead of uridine to dampen innate immune sensing and to increase mRNA translation in vivo15. Assay results are reported in U/ml of IgG. Upcoming reports of Project Lightspeed will present the data obtained for other COVID-19 vaccine candidates, including BNT162b2, the RNA-based vaccine candidate that encodes the full-length SARS-CoV-2 spike glycoprotein and is being tested in a phase III efficacy trial32. Elevated CRP levels are almost always associated with otherrisk factors for heart disease, including: Talk to your healthcare provider about your heart disease risk factors and what can be done to address them and your CRP levels. 27, 824836 (2019). 4 ac, Extended Data Table 6). Little is known about normal reference values of CRP during the perinatal period as several factors are able to influence it. Information on this website is provided for informational purposes only and is not intended as a substitute for the advice provided by your physician or other healthcare professional. The patient came to our clinic on Jan 22, 202130 days after receiving the first BNT162b2 vaccination, and 9 days after the second vaccinationhe had clinically significant swelling and warmth over the right knee with pain on flexion and extension of the knee. By continuing to browse this site, you are agreeing to our use of cookies. Get what matters in translational research, free to your inbox weekly. CRP stands forC-reactive protein, which is produced by the liver and regarded as a general indicator of inflammation in the body. Orlandini von Niessen, A. G. et al. Nature (Nature) 2b), and the vaccine elicited lower ratios of serum-neutralizing GMT to RBD-binding IgG GMC than did infection with SARS-CoV-2. In this case series, researchers used data from patients admitted to a public health treatment . Commun. A coronary artery disease risk assessment should be based on the average of two hs-CRP tests. Virology 329, 1117 (2004). Methods: Plasma CRP levels at hospital admission and 14-day all-cause mortality were assessed in geriatric inpatients hospitalized for COVID-19. and M.V. PubMedGoogle Scholar. Data shown as group GMT with 95% CI. HIV Clin Trials. Nucleoside-modified mRNA vaccines induce potent T follicular helper and germinal center B cell responses. The next evening, she developed a fever (39C). All authors have completed the International Committee of Medical Journal Editors (ICMJE) uniform disclosure form at https://www.gisaid.orgwww.icmje.org/coi_disclosure.pdf` and declare: U.S. and .T. In the meantime, to ensure continued support, we are displaying the site without styles A Correction to this paper has been published: https://doi.org/10.1038/s41586-020-03102-w. Mulligan, M. J. et al. If you are a Mayo Clinic patient, this could Inflammation is an important contributor to atherosclerosis and elevated CRP is associated with an increased risk of CAD. Reactogenicity was dose-dependent, and was more pronounced after the boost dose. Whether a CRP level is dangerous will depend on the type of c-reactive protein test used, your individual medical history, and the suspected cause of inflammation. Similarly, fractions of RBD-specific CD8+ T cells secreted IFN+ and IL-2. Multiscreen filter plates (Merck Millipore) pre-coated with IFN-specific antibodies (ELISpotPro kit, Mabtech) were washed with PBS and blocked with X-VIVO 15 medium (Lonza) containing 2% human serum albumin (CSL-Behring) for 15 h. Per well, 3.3 105 effector cells were stimulated for 1620 h with an overlapping peptide pool representing the vaccine-encoded RBD. Epub 2020 Jun 25. advised on experiments. C-reactive protein is measured in milligrams per liter (mg/L). RNA-Based COVID-19 vaccine BNT162b2 selected for a pivotal efficacy study. 2019 ACC/AHA Guideline on the primary prevention of cardiovascular disease: Executive summary: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. c, Kinetics of neutrophil counts. Release 217, 345351 (2015). Is that true, and is it dangerous? Adrenal conditions. COVID-19 convalescent samples (HCS, n=38) were obtained at least 14 days after PCR-confirmed diagnosis and at a time when the donors were no longer symptomatic. Cardiovascular disease: Risk assessment with nontraditional risk factors. 3-5. Lipid nanoparticle (LNP)-formulated mRNA vaccine technology allows the delivery of precise genetic information together with an adjuvant effect to antigen-presenting cells4. Moderate elevation refers to levels between 1.0 mg/dl and 10.0 mg/dl, which can signal a more significant issue. 2022 May;14(5):202-208. doi:10.14740/jocmr4730. How can one naturally lower an elevated CRP count? High CRP in COVID-19 is associated with complications of the coronavirus, including venous thromboembolism, acute kidney injury, critical illness, and mortality. Arrowheads indicate days of vaccination. All 17 variants were efficiently neutralized by the five tested BNT162b1 immune sera. Study BNT162-01 (NCT04380701) is an ongoing, first-in-human, phase I/II, open-label dose-ranging clinical trial to assess the safety, tolerability, and immunogenicity of ascending dose levels of various intramuscularly administered BNT162 mRNA vaccine candidates in healthy men and non-pregnant women 18 to 55 years of age (amended to add 5685 years of age). Among participants who showed any vaccine-induced CD8+ T cell response (32/42 participants receiving the prime-boost dosing, 76.2%), the majority mounted strong responses (Fig. Allergic reactions. Each serum was tested in duplicate and GMT plotted. Intracellular staining was performed in Perm/Wash buffer for 30min at 4C (CD3 BV421, 1:250; CD4 BV480, 1:50; CD8 BB515, 1:100; IFN PE-Cy7, 1:50; IL-2 PE, 1:10; IL-4 APC, 1:500; all BD Biosciences). It could be that it merely reflects the vascular injury and inflammation that results from other risk factors. Antiphospholipid antibodies were. Int. So it's possible to have a high hs-CRP level without it affecting the heart. Kishimoto Y, Aoyama M, Saita E, Ohmori R, Tanimoto K, Kondo K, et al. Karik, K. et al. She is generally healthy. It can take a few days to get results. U.S.and .T., supported by M.B., E.D., P.R.D., K.U.J., L.M.K., A.M., I.V. While it is still uncertain how important it is to reduce elevated CRP, experts have identified several ways of doing so. 2023 Dotdash Media, Inc. All rights reserved, Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Destexhe, E. et al. T cell responses stimulated by peptides were compared to effectors incubated with medium only as a negative control using an in-house ELISpot data analysis tool (EDA), based on two statistical tests (distribution-free resampling) as described35,36, to provide sensitivity while maintaining control over false positives. or Healthy Lifestyle Brands. optimized the mRNA. 3C at 5 days after the second dose of the vaccine, approximately one month after the first dose. Follow along on Facebook and join the lively conversation! To obtain Dis. Cells were stained for viability and surface markers (CD3 BV421, 1:250; CD4 BV480, 1:50; CD8 BB515, 1:100; all BD Biosciences) in flow buffer (DPBS (Gibco) supplemented with 2% FBS (Biochrom), 2mM EDTA (EDTA; Sigma-Aldrich) for 20min at 4C. It may be recommended for some people with elevated CRP who are at a higher risk of heart disease or who have already experienced one of these consequences. Two phaseI/II umbrella trials in Germany and the USA are investigating several LNP-encapsulated RNA vaccine candidates developed in Project Lightspeed, the joint BioNTech-Pfizer COVID-19 RNA vaccine development program. High c-reactive protein (CRP) is a sign of inflammation in the body, which puts you at risk for a number of disorders. For pseudovirus neutralization assays, Vero cells (ATCC CCL-81) were seeded in 96-well plates in culture medium and allowed to reach approximately 85% confluence before use in the assay (24h later). c, RBD-specific CD4+ and CD8+ T cell-responses in all participants who received prime and boost vaccination (n=42) with a positive response to RBD and their baseline CEFT- and CEF-specific T cell responses. U.S. Preventive Task Force. Viral master stocks (2 107 PFU/ml) were grown in Vero E6 cells as previously described33. Type I interferons directly regulate lymphocyte recirculation and cause transient blood lymphopenia. 1) with CD4+ T cell responses on day 29 (as in Fig. Plates were scanned using an AID Classic Robot ELISPOT Reader and analysed by AID ELISPOT 7.0 software (AID Autoimmun Diagnostika). doi:10.1097/md.0000000000007822. It acts in synergy with type I interferons to inhibit the replication of SARS-CoV25. Extended Data Fig. Total cell counts per well were enumerated by nuclear stain (Hoechst 33342) and fluorescent virally infected foci were detected 1624 h after inoculation with a Cytation 7 Cell Imaging Multi-Mode Reader (BioTek) with Gen5 Image Prime version 3.09. 2012;13(3):153-61. doi:10.1310/hct1303-153. is an employee at Bexon Clinical Consulting LLC. Sahin, U., Muik, A., Derhovanessian, E. et al. 145, 323327 (2005). To assess the functionality and polarization of RBD-specific T cells, we identified cytokines secreted in response to stimulation with overlapping peptides representing the full-length sequence of the vaccine-encoded RBD by intracellular staining (ICS) for IFN, IL-2 and IL-4 in PBMCs collected before and after vaccination from 52 participants who had been immunized with BNT162b1. mRNA is transiently expressed and does not integrate into the genome. a, RBD-specific CD4+ and CD8+ T cell responses for each dose cohort. Accessed Nov. 15, 2022. I hope this helps you with your patient. Statins shown to bring down CRP levels and reduce related cardiac risks include: If you have high CRP levels, especially if you have one or more additional risk factors for heart disease, you should discuss the option of taking a statin drug with your healthcare provider. Seven days after the boosting dose (day 29), RBD-binding IgG GMCs in participants vaccinated with 150 g BNT162b1 showed a strong, dose-dependent booster response ranging from 2,015 to 25,006Uml1. This can be caused by a variety of factors, including: Parasitic and fungal diseases. Based on the more favourable systemic tolerability, BNT162b2 was selected to advance into a phase II/III trial. She always had normal urinalysis (before and after COVID-19 shot). Elevated CRP is associated with increased risk of heart disease. For values below the LLOQ=20, LLOQ/2 values were plotted. Internet Explorer). Feldman, R. A. et al. The bottom line is that a temporary elevation in CRP level is to be expected after a vaccine. This is known as intermediate risk. The ratio of serum virus neutralization GMT to recombinant RBD-binding IgG GMC is lower after immunization with BNT162b1 than after infection with SARS-CoV-2. planned and supervised dashboards for analysis of clinical trial data. are employees at BioNTech RNA Pharmaceuticals GmbH; M.B. All Rights Reserved. Influenza vaccination results in acute phase response (APR) in men with and without severe carotid artery disease. When c-reactive protein (CRP) is high, it's a sign of inflammation in the body. A description of the durability of the antibody response to BNT162b1 will emerge over the planned six months of serological follow up in this study and two years of follow up in the corresponding USA study. A long-term trend based on the contraction phase cannot be extrapolated. C-reactive protein in cardiovascular disease. C.B. the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Google Scholar. Recently, we reported interim data obtained in the USA trial (NCT04368728) for the most advanced candidate, BNT162b11. No history of viral illnesses or other vaccines in this April or May. Erratum in: Nature. Her kidney function remained abnormal for at least a month. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. The robust elicitation of IFN-producing CD8+ T cells indicates that a favourable cellular immune response with anti-viral and immune-augmenting properties complements the strong neutralizing antibody response. It was not checked previously. 2). Although there were no relevant changes in routine clinical laboratory values after vaccination with BNT162b1, vaccinated participants showed a transient increase in C-reactive protein. Ratios above post-vaccination data points are the number of participants with a detectable CD4+ or CD8+ T cell response out of the total number of tested participants per dose cohort. Nature https://doi.org/10.1038/s41586-020-2639-4 (2020). Learn your the risk of a second heart attack. Studies have shown that they can reduce CRP levels by 13% to 50%. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which was identified in China in December 2019, causes coronavirus disease 2019 (COVID-19)a severe, acute respiratory syndrome with a complex, highly variable disease pathology. Influenza vaccination produces a mild CRP response in the Philippines. Dotted lines indicate upper and lower limit of reference range. Horizontal bars indicate median. Characterization of HIV-1 nucleoside-modified mRNA vaccines in rabbits and rhesus macaques. Capping is performed co-transcriptionally using a trinucleotide cap 1 analogue ((m27,3-O)Gppp(m2-O)ApG; TriLink). All participants provided written informed consent. In brief, human codon-optimized SARS-CoV-2 spike (GenBank: MN908947.3) was synthesized (Genscript) and cloned into an expression plasmid. 2a, Extended Data Table 4). Everything was back to normal, except estimated GFR was still low at 53 mL/min. Because of the reactogenicity reported after the 50-g boost dose, participants who had received an initial 60-g dose did not receive a boost injection. Serum was obtained on day 1 (pre-prime), 81 (post-prime), 222 (pre-boost), 293 and 434 (post-boost). Nucleic Acids 15, 3647 (2019). However, daily aspirin therapy can be used as a heart attack and stroke prevention measure, but the risks of taking aspirin for prevention may outweigh the benefits.
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