Atherosclerosis and cardiovascular events: Aspirin for primary prevention
DISEASE INTERVENTION COMPARISON RESULTS
Eur Heart J. 2018 Dec 17. doi: 10.1093/eurheartj/ehy813. Meta-Analysis
IN atherosclerosis, cardiovascular disease, primary prevention, all ages, all patients, diabetic and high cardiovascular risk patients The Use of
aspirin
As Prevention, Primary
Is worse Than
placebo
To modify all-cause mortality or cardiovascular events (lower inicdence of myocardial infarction, but heterogeneous). Conversely, aspirin increased major bleeding (RR 1.5) and intracranial haemorrhage (RR 1.33)
N Engl J Med. 2018 Oct 18;379(16):1499-1508 Randomized Controlled Trial, Multicenter Study
IN atherosclerosis, cardiovascular disease, primary prevention, healthy old patients The Use of
aspirin, 100 mg daily
As Prevention, Primary
Is worse Than
placebo
To achieve any clinical benefit (composite of death, dementia or persistent physical disability 2.1%/year in both groups) and caused more major bleeding (3.8% aspirin VS 2.8% placebo)
N Engl J Med. 2018 10 18;379(16):1519-1528 Randomized Controlled Trial, Multicenter Study
IN atherosclerosis, cardiovascular disease, primary prevention, healthy old patients The Use of
aspirin, 100 mg daily
As Prevention, Primary
Is worse Than
placebo
To carry any benefit: it increased all-cause death (1.3 %/year aspirin VS 1.1%/year placebo, p significant), mainly caused by cancer.
N Engl J Med. 2018 Oct 18;379(16):1529-1539. doi: 10.1056/NEJMoa1804988 Randomized Controlled Trial, Multicenter Study
IN atherosclerosis, cardiovascular disease, primary prevention, high risk patients, diabetes mellitus, type 2 The Use of
aspirin, 100 mg daily
As Treatment, Chronic
Is better Than
placebo
To reduce at 7.4 years cardiovascular events (8.5% VS 9.5% placebo), but it increased major bleeding (4% aspirin VS 3% placebo), most of the excess being gastrointestinal bleeding and other extracranial bleeding.
Lancet. 2009 May 30;373(9678):1849-60 Meta-Analysis
IN atherosclerosis, coronary disease, stroke, ischemic, cardiovascular death The Use of
aspirin
As Prevention, Primary
Is better Than
placebo
To reduce, both as primary or secondary prevention, serious cardiovascular events but increasing major bleeding. Benefit for primary prevention was limited: 0.51% events aspirin VS 0.57% placebo, 0.10% major bleedings aspirin VS 0.07% placebo
Ann Intern Med. 2009 Mar 17;150(6):405-10 Systematic Review
IN atherosclerosis, coronary disease, stroke, ischemic, cardiovascular death The Use of
aspirin
As Prevention, Primary
Is better Than
placebo
To reduce cardiovascular events (myocardial infarction in men and strokes in women) but not cardiovascular death or overall mortality. Aspirin use increases serious bleeding events.