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Primary prevention of myocardial infarction: aspirin is not as useful as it seems

Yi Luan1, Ya Li1, Liding Zhao1

  • 1Department of Cardiology, Provincial Key Laboratory of Cardiovascular Intervention and Heart Regeneration, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou 310016, China.

Annals of Translational Medicine
|May 2, 2020
PubMed

Insights

Aspirin may not significantly prevent all myocardial infarctions, including silent ones, in primary prevention. Including silent myocardial infarctions (SMI) diminishes the previously observed protective effect of aspirin.

Area of Science:

  • Cardiology
  • Pharmacology
  • Preventive Medicine

Background:

  • Aspirin is known to prevent symptomatic myocardial infarction but its effect on all myocardial infarctions, including silent myocardial infarctions (SMI), is unclear.
  • Silent myocardial infarctions are prevalent in clinical practice, yet no meta-analysis has specifically compared aspirin's effect on primary prevention of all myocardial infarctions, including SMI.

Purpose of the Study:

  • To conduct a meta-analysis comparing the effect of aspirin administration on the primary prevention of all myocardial infarctions, including SMI.

Main Methods:

  • Systematic literature search of PubMed, Embase, Web of Science, Cochrane Library, and Google Scholar.
  • Inclusion of randomized double-blind controlled trials evaluating aspirin for primary prevention of myocardial infarctions.
  • Meta-analysis of data from 9 trials involving 67,486 patients and 67,557 controls.

Main Results:

  • Aspirin's primary preventive effect on all myocardial infarctions, when including SMI, was not as significant as expected.
  • The risk ratio (RR) for myocardial infarction was 0.883 (95% CI: 0.780 to 1.001; P=0.052) when SMI was included.

Conclusions:

  • Aspirin may not offer a primary preventive benefit for all patients experiencing myocardial infarction.
  • The previously observed reduction in myocardial infarction incidence with aspirin is not evident when silent myocardial infarctions are included in the analysis.
Abstract

Keywords:
Aspirinmyocardial infarctionprimary prevention

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