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Update on aspirin in the treatment and prevention of cardiovascular disease
1Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA.
Insights
Low-dose aspirin effectively reduces cardiovascular events in patients with existing cardiovascular disease or acute myocardial infarction (MI). However, its role in primary prevention, especially for women, requires further research before definitive conclusions can be drawn.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Preventive Cardiology
Background:
- Low-dose aspirin is widely studied for cardiovascular disease prevention.
- Its efficacy varies across different patient populations and prevention strategies.
Purpose of the Study:
- To review the evidence on low-dose aspirin's effects on cardiovascular disease outcomes.
- To evaluate its benefits in secondary prevention and primary prevention settings.
Main Methods:
- Analysis of randomized controlled trials in three population types: established cardiovascular disease, acute myocardial infarction (MI), and healthy subjects.
- Review of data from ongoing large-scale trials, such as the Women's Health Study.
Main Results:
- Aspirin significantly reduces risks of nonfatal MI, nonfatal stroke, and vascular death in patients with prior occlusive cardiovascular disease.
- Early aspirin initiation (within 24 hours) in acute MI lowers risks of reinfarction, stroke, and death.
- Aspirin reduces the risk of a first MI in men, but data for stroke and total mortality in primary prevention are inconclusive, especially for women.
Conclusions:
- Low-dose aspirin is beneficial for secondary prevention in cardiovascular disease and acute MI.
- Evidence for primary prevention is limited, particularly in women, necessitating further research.
- Clinical decisions regarding primary prevention should consider individual risk factors and physician judgment.
Abstract:
The effects of low-dose aspirin on cardiovascular disease have been tested in randomized trials in 3 types of populations: (1) patients with a history of cardiovascular disease; (2) patients with evolving acute myocardial infarction (MI), and (3) apparently healthy subjects. In a very wide range of patients with prior occlusive cardiovascular disease, aspirin reduces the risks of nonfatal MI, nonfatal stroke, and vascular death. Initiating aspirin therapy within 24 hours after the onset of symptoms of an acute MI also confers conclusive reductions in the risk of nonfatal reinfarction, nonfatal stroke, and total cardiovascular death. In primary prevention trials, aspirin has been shown to reduce the risk of a first MI in men, but the data on stroke and total cardiovascular death are not sufficient to allow firm conclusions to be drawn; randomized data from studies in women are not yet available. The Women's Health Study, an ongoing large-scale trial in female health care professionals, will provide the data necessary to assess the balance of benefits and risks of aspirin in primary prevention. Until then, the decision to use aspirin in primary prevention should be based on the clinical judgment of the physician and considered as an adjunct in the management of other cardiovascular disease risk factors.
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