PURL:Rethinking daily aspirin for primary prevention

Area of Science:

• Cardiology
• Preventive Medicine
• Clinical Trials

Background:

• Aspirin is widely used for secondary prevention of cardiovascular events.
• Its role in primary prevention for individuals without established atherosclerotic cardiovascular disease (CVD) remains debated.

Purpose of the Study:

• To evaluate the efficacy and safety of aspirin for primary prevention of atherosclerotic CVD.
• To provide updated evidence based on recent randomized controlled trials (RCTs).

Main Methods:

• Systematic review and meta-analysis of recent RCTs.
• Inclusion of studies focusing on individuals without a history of atherosclerotic CVD.
• Assessment of cardiovascular events, bleeding events, and all-cause mortality.

Main Results:

• The meta-analysis indicates no significant reduction in major adverse cardiovascular events with aspirin use for primary prevention.
• An increased risk of gastrointestinal bleeding and other hemorrhagic events was observed.
• No significant benefit in reducing all-cause mortality was found.

Conclusions:

• Current evidence from updated RCTs does not support the routine use of aspirin for primary prevention of atherosclerotic CVD.
• The potential harms, particularly bleeding risks, outweigh the uncertain benefits in this population.
• Clinical guidelines should be updated to reflect these findings, discouraging aspirin use in individuals without established CVD.