Aspirin for primary stroke prevention in elderly patients with vascular risk factors

The effect of aspirin in primary stroke prevention is controversial in Western population, and no evidence is available in Asian population. We performed stroke subanalysis of the Japanese Primary Prevention Project (JPPP), which was a randomized controlled trial of aspirin vs no aspirin for primary prevention of vascular events in 14 464 patients aged over 60 years with hypertension, diabetes, and/or dyslipidemia. We evaluated the effects of aspirin on the risk of stroke and intracranial hemorrhage. Aspirin did not show any net benefit for primary stroke prevention during median follow-up for 5 years, because nonsignificant reduction in ischemic stroke was offset by nonsignificant increase in hemorrhagic stroke. Aspirin is not recommended for primary stroke prevention in elderly Japanese patients with vascular risk factors in general. Asymptomatic large artery atherosclerosis appears to be a new target for primary prevention of stroke.