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Low-dose aspirin in patients with stable cardiovascular disease: a meta-analysis
Jeffrey S Berger1, David L Brown, Richard C Becker
1Duke Clinical Research Institute, Durham, NC 27710, USA. berge026@mc.duke.edu
Insights
Low-dose aspirin significantly reduces cardiovascular events and all-cause mortality in stable cardiovascular disease patients. However, it also increases the risk of severe bleeding events.
Area of Science:
- Cardiology
- Pharmacology
- Preventive Medicine
Background:
- Current recommendations for aspirin in cardiovascular disease often aggregate data from various antiplatelet therapies, dosages, and patient populations (stable and unstable).
- There is a need to specifically evaluate the efficacy and safety of low-dose aspirin in patients with stable cardiovascular disease.
Purpose of the Study:
- To assess the benefits and risks of low-dose aspirin (50-325 mg/day) for secondary prevention in patients diagnosed with stable cardiovascular disease.
Main Methods:
- A systematic review and meta-analysis of secondary prevention randomized controlled trials (RCTs) of low-dose aspirin in stable cardiovascular disease patients.
- Searches were conducted in the MEDLINE database from 1966 to 2006, identifying six RCTs involving patients with prior myocardial infarction, stable angina, or stroke/transient ischemic attack.
- A random effects model was employed to synthesize the results from the included individual trials.
Main Results:
- The meta-analysis included 9,853 patients across six studies. Low-dose aspirin therapy demonstrated a significant 21% reduction in major cardiovascular events (nonfatal myocardial infarction, nonfatal stroke, cardiovascular death) (95% CI, 0.72-0.88).
- Aspirin significantly reduced the risk of nonfatal myocardial infarction by 26% (95% CI, 0.60-0.91) and nonfatal stroke by 25% (95% CI, 0.65-0.87). All-cause mortality was reduced by 13% (95% CI, 0.76-0.98).
- Conversely, aspirin use was associated with a significant increase in severe bleeding events (OR 2.2, 95% CI, 1.4-3.4). For every 1000 patients treated for 33 months, 33 cardiovascular events and 9 major bleeding events would be prevented/caused, respectively.
Conclusions:
- Low-dose aspirin therapy is effective in reducing adverse cardiovascular events and all-cause mortality among patients with stable cardiovascular disease.
- The benefits of aspirin in reducing cardiovascular events must be weighed against its associated increased risk of severe bleeding.
- Aspirin's efficacy varied by condition, being most effective for nonfatal myocardial infarction and all-cause mortality in ischemic heart disease, and stroke reduction in cerebrovascular disease.
Objective:
Many recommendations for aspirin in stable cardiovascular disease are based on analyses of all antiplatelet therapies at all dosages and in both stable and unstable patients. Our objective was to evaluate the benefit and risk of low-dose aspirin (50-325 mg/d) in patients with stable cardiovascular disease.
Methods:
Secondary prevention trials of low-dose aspirin in patients with stable cardiovascular disease were identified by searches of the MEDLINE database from 1966 to 2006. Six randomized trials were identified that enrolled patients with a prior myocardial infarction (MI) (n=1), stable angina (n=1), or stroke/transient ischemic attack (n=4). A random effects model was used to combine results from individual trials.
Results:
Six studies randomized 9853 patients. Aspirin therapy was associated with a significant 21% reduction in the risk of cardiovascular events (nonfatal MI, nonfatal stroke, and cardiovascular death) (95% confidence interval [CI], 0.72-0.88), 26% reduction in the risk of nonfatal MI (95% CI, 0.60-0.91), 25% reduction in the risk of stroke (95% CI, 0.65-0.87), and 13% reduction in the risk of all-cause mortality (95% CI, 0.76-0.98). Patients treated with aspirin were significantly more likely to experience severe bleeding (odds ratio 2.2, 95% CI, 1.4-3.4). Treatment of 1000 patients for an average of 33 months would prevent 33 cardiovascular events, 12 nonfatal MIs, 25 nonfatal strokes, and 14 deaths, and cause 9 major bleeding events. Among those with ischemic heart disease, aspirin was most effective at reducing the risk of nonfatal MI and all-cause mortality; however, among those with cerebrovascular disease, aspirin was most effective at reducing the risk of stroke.
Conclusion:
In patients with stable cardiovascular disease, low-dose aspirin therapy reduces the incidence of adverse cardiovascular events and all-cause mortality, and increases the risk of severe bleeding.
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