[Aspirin for primary cardiovascular prevention : the end of an era ?]

Area of Science:

• Cardiology
• Preventive Medicine
• Clinical Trials

Background:

• The use of low-dose aspirin for primary prevention of cardiovascular disease (CVD) remains controversial.
• Recent clinical trials comparing aspirin to placebo have indicated a negative risk-benefit profile.
• These trials reported an increase in major bleeding events without a corresponding decrease in non-fatal cardiovascular events.

Purpose of the Study:

• To evaluate the current risk-benefit ratio of low-dose aspirin in primary CVD prevention.
• To assess the accuracy of existing cardiovascular risk calculators in light of contemporary risk factor management.
• To provide evidence-based recommendations aligned with European guidelines.

Main Methods:

• Systematic review and meta-analysis of recent randomized controlled trials (RCTs) of aspirin versus placebo for primary CVD prevention.
• Analysis of data on major bleeding events and non-fatal cardiovascular outcomes.
• Comparison of predicted cardiovascular risk from standard calculators versus observed event rates.

Main Results:

• Recent RCTs demonstrate an unfavorable risk-benefit ratio for aspirin in primary prevention.
• A significant increase in major bleeding complications was observed.
• No significant reduction in the incidence of non-fatal cardiovascular events was found.
• Current cardiovascular risk calculators appear to overestimate risk, likely due to improved cardiovascular risk factor management.

Conclusions:

• Low-dose aspirin should not be prescribed for the primary prevention of cardiovascular disease.
• The findings support updated European cardiovascular prevention recommendations.
• Re-evaluation of cardiovascular risk assessment tools is warranted.