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Meta-analysis of data from the six primary prevention trials of cardiovascular events using aspirin
Alfred A Bartolucci1, George Howard
1The Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA. abartol@uab.edu
Insights
Aspirin (acetylsalicylic acid) significantly reduces the risk of total coronary heart disease (CHD) and nonfatal myocardial infarction (MI). This meta-analysis confirms aspirin
Area of Science:
- Cardiology
- Preventive Medicine
- Clinical Trials
Background:
- The role of aspirin in primary prevention of cardiovascular (CV) events remains debated despite previous studies.
- Five major studies have informed current guidelines, but their collective impact requires further evaluation.
- Aspirin (acetylsalicylic acid) is widely considered for CV risk reduction.
Purpose of the Study:
- To evaluate the benefits of aspirin for primary prevention of CV events.
- To conduct a meta-analysis of six major randomized trials assessing aspirin's efficacy.
- To analyze key CV endpoints including coronary heart disease, myocardial infarction, stroke, and mortality.
Main Methods:
- Meta-analysis of six randomized controlled trials: British Doctors' Trial, Physicians' Health Study, Thrombosis Prevention Trial, Hypertension Optimal Treatment study, Primary Prevention Project, and Women's Health Study.
- Combined sample size of 47,293 subjects on aspirin and 45,580 on placebo.
- Assessment of six CV endpoints: total CHD, nonfatal MI, total CV events, stroke, CV mortality, and all-cause mortality; analysis included tests for treatment effect, heterogeneity, and study size bias.
Main Results:
- Aspirin demonstrated superiority in reducing total coronary heart disease (CHD) and nonfatal myocardial infarction (MI) (p < 0.001 for both).
- Significant reduction observed in total cardiovascular (CV) events (p < 0.001).
- A nonsignificant trend towards decreased risk was noted for stroke, CV mortality, and all-cause mortality (0.07 < p < 0.34); no evidence of statistical bias was found (p > 0.05).
Conclusions:
- Primary prevention with aspirin significantly decreases the risk of total CHD, nonfatal MI, and overall CV events in a large patient sample.
- No statistically significant differences were observed in the incidences of stroke or CV mortality.
- The findings support the use of aspirin for primary prevention of specific cardiovascular events.
Abstract:
Until recently, 5 major studies have formed the basis for the use of aspirin (acetylsalicylic acid) in primary prevention of cardiovascular (CV) events. Despite these data, the role of aspirin in primary prevention has not been established firmly. Six randomized trials have evaluated the benefits of aspirin for the primary prevention of CV events: the British Doctors' Trial, the Physicians' Health Study, the Thrombosis Prevention Trial, the Hypertension Optimal Treatment study, the Primary Prevention Project, and the Women's Health Study. The combined sample consists of 47,293 subjects on aspirin and 45,580 not on aspirin or placebo. A meta-analysis of these 6 trials assessed 6 CV end points: total coronary heart disease (CHD), nonfatal myocardial infarction (MI), total CV events, stroke, CV mortality, and all-cause mortality. No covariate adjustment was performed and appropriate tests for treatment effect, heterogeneity, and study size bias were applied. Using odds ratios and confidence intervals, the meta-analysis suggested superiority of aspirin for total CHD, nonfatal MI, and total CV events (p < or =0.001 in each case), with a nonsignificant trend (0.07 < p <0.34) for decreased risk of stroke, CV mortality, and all-cause mortality. There was no evidence of statistical bias (p >0.05). Given the study size and cohort, aspirin decreased the risk of CV events in this large patient sample. In conclusion, primary prevention with aspirin decreased the risk of total CHD, nonfatal MI, and total CV events, but there were no significant differences in the incidences of stroke or CV mortality.
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