Related Experiment Video
Updated: May 20, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Association of Aspirin Use in Primary Prevention and Cardiovascular Events: A Retrospective Analysis of the VITAL
Daniel Caldeira1,2,3,4, Mariana Alves4,5, Nilza Gonçalves4
1Centro Cardiovascular da Universidade de Lisboa-CCUL@RISE, Centro Académico de Medicina de Lisboa (CAML), Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisbon, Portugal.
Insights
Aspirin use in primary prevention did not reduce cardiovascular death or major events in the VITAL study. This research suggests aspirin may not be beneficial for preventing cardiovascular outcomes in the general population.
Area of Science:
- Cardiology
- Preventive Medicine
- Clinical Pharmacology
Background:
- Aspirin is a key antithrombotic agent for established cardiovascular disease.
- Personalized medicine aims to optimize aspirin therapy for individual risk-benefit profiles.
- The role of aspirin in primary cardiovascular prevention remains controversial.
Purpose of the Study:
- To evaluate the risks and benefits of aspirin for primary cardiovascular prevention.
- To analyze aspirin's association with mortality and major cardiovascular events using VITAL study data.
Main Methods:
- Retrospective analysis of the prospective VITAL cohort study.
- Participants categorized by aspirin usage (users vs. non-users).
- Outcomes assessed: all-cause mortality, cardiovascular mortality, major adverse cardiovascular events (MACE), myocardial infarction, coronary heart disease, stroke, and hemorrhagic stroke.
- Statistical analysis using hazard ratios (HRs) with 95% confidence intervals (CIs), adjusted for covariates.
Main Results:
- Aspirin users were older, more frequently male, had higher BMI, and lower smoking rates.
- Adjusted analyses showed no significant association between aspirin use and reduced cardiovascular death (HR 1.17, 95%CI 0.89-1.55).
- Aspirin was not associated with a lower risk of major cardiovascular events (HR 1.04, 95%CI 0.89-1.22), coronary heart disease (HR 1.16, 95%CI 0.98-1.37), or stroke (HR 1.01, 95%CI 0.77-1.31).
Conclusions:
- In this retrospective VITAL cohort analysis, aspirin was not linked to a decreased risk of cardiovascular mortality.
- Aspirin use was not associated with a reduction in major cardiovascular events or stroke.
- Findings suggest aspirin may not offer significant primary prevention benefits for cardiovascular outcomes in this population.
Abstract:
Background: Aspirin is part of the therapeutic antithrombotic armamentarium for the management of patients with established clinically relevant atherosclerosis or thrombotic cardiovascular disease. Personalized medicine identifies those who benefit most or face fewer risks from aspirin. The role of aspirin in primary prevention is still debatable. We aimed to assess the risks and benefits of aspirin in this setting, using the data of the prospective VITAL (VITamins and Lifestyle) study. Methods: We conducted a retrospective evaluation of the VITAL cohort. In this analysis, participants were split according to aspirin usage. Aspirin use was evaluated regarding all-cause mortality, CV mortality, major cardiovascular event (MACE), myocardial infarction, coronary heart disease, total stroke, and hemorrhagic stroke. The hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated to explore the association between cardiovascular events and aspirin usage. The estimates were adjusted for demographic and clinical variables. Results: The aspirin users (n = 11,570) were older, more frequently men, the body mass index was higher, and the proportion of smokers was smaller compared with non-users (n = 13,927). After adjusting for demographic and clinical variables, aspirin was not identified as a predictor of cardiovascular death (HR 1.17, 95%CI 0.89 to 1.55), major cardiovascular events (HR 1.04, 95%CI 0.89 to 1.22), coronary heart disease (HR 1.16, 95%CI 0.98 to 1.37), nor stroke (HR 1.01, 95%CI 0.77 to 1.31). Conclusion: In this retrospective analysis of the VITAL cohort, aspirin was not associated with a reduced risk of cardiovascular mortality or events.
Related Concept Videos
01:20Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
01:18Cardiovascular Drugs: Classification based on Therapeutic Indications
01:18Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
01:23Assessment of the Cardiovascular System I: Subjective Data
Initial Enquiry
Ask the patient about their primary concern and thoroughly explore all reported symptoms.
Medical History
Investigate past illnesses affecting the cardiovascular system, such as angina, anemia, rheumatic fever, congenital heart disease, stroke, thrombophlebitis, dysrhythmias, varicosities
Inquire about symptoms...
01:23Treatment for Pulmonary Arterial Hypertension: Prostacyclin Receptor Agonists
These agonists bind to the IPR receptor situated on the plasma membrane of the pulmonary artery smooth muscle cells. This binding triggers a cascade of reactions known as the GS-AC-cAMP-PKA pathway. This pathway results in the relaxation of smooth muscle...
01:30Preventive Healthcare Services