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Effect of aspirin on vascular and nonvascular outcomes: meta-analysis of randomized controlled trials

Sreenivasa Rao Kondapally Seshasai1, Shanelle Wijesuriya, Rupa Sivakumaran

  • 1St George's University of London, London, England. rkondapa@sgul.ac.uk

Archives of Internal Medicine
|January 11, 2012
PubMed

Insights

Aspirin use in primary prevention significantly reduced nonfatal myocardial infarctions but did not lower cardiovascular death or cancer mortality. Increased bleeding risks mean routine aspirin prophylaxis is not recommended.

Area of Science:

  • Cardiovascular disease prevention
  • Clinical trials and meta-analysis
  • Pharmacological interventions

Background:

  • The net benefit of aspirin for primary prevention of cardiovascular disease (CVD) and nonvascular events is not well-established.
  • Uncertainty exists regarding the overall impact and safety profile of aspirin in individuals without pre-existing CVD.

Purpose of the Study:

  • To assess the efficacy and safety of aspirin in primary prevention of vascular and nonvascular outcomes.
  • To evaluate the balance between CVD risk reduction and bleeding risk associated with aspirin use.

Main Methods:

  • A systematic review and meta-analysis of nine randomized placebo-controlled trials.
  • Inclusion criteria required at least 1000 participants and reporting on CVD, nonvascular outcomes, or death.
  • Data extraction and analysis involved combining study-specific odds ratios using random-effects meta-analysis.

Main Results:

  • Over 100,000 participants showed aspirin reduced total CVD events by 10% (NNT 120), mainly nonfatal myocardial infarction (MI) (NNT 162).
  • No significant reduction was observed in CVD death or cancer mortality.
  • Aspirin increased the risk of nontrivial bleeding events (NNH 73), with significant heterogeneity noted for coronary heart disease and bleeding outcomes.

Conclusions:

  • Aspirin prophylaxis in primary prevention significantly reduces nonfatal MI but not cardiovascular death or cancer mortality.
  • The benefits of aspirin are offset by an increased risk of clinically significant bleeding events.
  • Routine aspirin use for primary prevention is not warranted; treatment decisions should be individualized.
Abstract

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