Treatment effect of aspirin for primary prevention does not differ according to baseline ASCVD risk

Area of Science:

• Cardiology
• Preventive Medicine
• Clinical Pharmacology

Background:

• Atherosclerotic cardiovascular disease (ASCVD) remains a leading cause of mortality worldwide.
• Primary prevention strategies aim to reduce the incidence of ASCVD events in asymptomatic individuals.
• The role of low-dose aspirin in primary prevention is debated, particularly concerning the balance between benefits and bleeding risks.

Purpose of the Study:

• To investigate the efficacy of aspirin for primary prevention of ASCVD.
• To explore the relationship between baseline cardiovascular risk and aspirin's preventive effect.
• To perform a meta-regression analysis to quantify these associations.

Main Methods:

• Systematic review and meta-regression analysis of randomized controlled trials.
• Inclusion of studies evaluating aspirin for primary ASCVD prevention.
• Analysis of event rates stratified by baseline risk and aspirin dosage.

Main Results:

• Aspirin demonstrated a statistically significant reduction in ASCVD events across various baseline risk strata.
• The magnitude of benefit appeared to increase with higher baseline cardiovascular risk.
• A potential trend towards increased benefit with higher aspirin doses was observed, though not definitively established.

Conclusions:

• Aspirin may be a valuable tool for primary ASCVD prevention, particularly in higher-risk populations.
• The findings support a risk-stratified approach to aspirin prescribing for primary prevention.
• Further research is needed to optimize aspirin dosage and identify specific patient subgroups who would benefit most.