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Aspirin for Primary Prevention of Cardiovascular Events

Hesham K Abdelaziz1, Marwan Saad2, Naga Venkata K Pothineni3

  • 1Lancashire Cardiac Center, Blackpool Victoria Hospital, Blackpool, United Kingdom; Department of Cardiovascular Medicine, Ain Shams University, Cairo, Egypt.

Journal of the American College of Cardiology
|June 15, 2019
PubMed

Insights

Aspirin use for primary prevention of cardiovascular disease (CVD) reduces nonfatal myocardial infarctions and strokes but increases major bleeding events. The overall benefit-risk profile remains under investigation for widespread recommendation.

Area of Science:

  • Cardiology
  • Preventive Medicine
  • Clinical Trials

Background:

  • The use of aspirin for primary prevention of cardiovascular disease (CVD) is a topic of ongoing debate.
  • Recent large-scale trials have added significant data, necessitating an updated analysis of aspirin's efficacy and safety.

Purpose of the Study:

  • To evaluate the clinical outcomes associated with aspirin for primary CVD prevention.
  • To incorporate data from over 45,000 new participants from recent large trials.

Main Methods:

  • A systematic review and meta-analysis of randomized controlled trials (RCTs) with a follow-up of at least one year.
  • Included efficacy outcomes (all-cause death, CV death, MI, stroke, TIA, MACE) and safety outcomes (major bleeding, intracranial bleeding, fatal bleeding, GI bleeding).
  • Calculated risk ratios (RRs) using random-effects DerSimonian-Laird models.

Main Results:

  • Analysis of 15 RCTs with 165,502 participants revealed aspirin was associated with a reduced risk of nonfatal myocardial infarction (MI), transient ischemic attack (TIA), and ischemic stroke.
  • However, aspirin significantly increased the risk of major bleeding, intracranial bleeding, and major gastrointestinal (GI) bleeding.
  • No significant differences were observed in all-cause death, cardiovascular death, or fatal bleeding between aspirin and control groups.

Conclusions:

  • Aspirin for primary prevention demonstrates a dual effect: reducing nonfatal ischemic events while increasing nonfatal bleeding events.
  • The findings highlight a trade-off between ischemic benefits and bleeding risks, impacting the decision for primary CVD prevention.
Abstract

Keywords:
aspirincardiovascular eventsprimary prevention

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