Aspirin for the primary prevention of cardiovascular events

Area of Science:

• Cardiology
• Gastroenterology
• Neurology

Background:

• Low-dose aspirin is widely studied for primary prevention of cardiovascular events.
• Evidence suggests efficacy in preventing myocardial infarction (MI) in men and ischemic stroke in women.
• Increased risk of major gastrointestinal (GI) bleeding is a known adverse effect.

Purpose of the Study:

• To evaluate the net benefit of low-dose aspirin for primary prevention of cardiovascular events.
• To assess the balance between the benefits of aspirin in preventing MI and stroke versus the risks of serious bleeding.

Main Methods:

• Systematic review and meta-analysis of existing evidence on low-dose aspirin for primary prevention.
• Analysis of risks including major GI hemorrhage and hemorrhagic stroke.
• Consideration of patient subgroups with specific risk factors like history of ulcer disease.

Main Results:

• Significant evidence supports low-dose aspirin for preventing first MI in men and ischemic stroke in women.
• A notable increase in major GI tract hemorrhage risk was observed.
• A non-significant increase in hemorrhagic stroke risk was suggested.

Conclusions:

• The benefits of low-dose aspirin (75-162 mg/day) in preventing MI in men and thrombotic stroke in women generally outweigh bleeding risks.
• In patients with a history of ulcer disease or GI bleeding, Helicobacter pylori eradication and proton pump inhibitor use are recommended with aspirin therapy.
• Aspirin is recommended for adults with a coronary heart disease risk exceeding 1% per year or 1% in 10 years.