Hesham K Abdelaziz1, Marwan Saad2, Naga Venkata K Pothineni3, Michael Megaly4, Rahul Potluri5, Mohammed Saleh6, David Lai Chin Kon7, David H Roberts7, Deepak L Bhatt8, Herbert D Aronow9, J Dawn Abbott10, Jawahar L Mehta11. 1. Lancashire Cardiac Center, Blackpool Victoria Hospital, Blackpool, United Kingdom; Department of Cardiovascular Medicine, Ain Shams University, Cairo, Egypt. 2. Department of Cardiovascular Medicine, Ain Shams University, Cairo, Egypt; Division of Cardiovascular Medicine, University of Arkansas for Medical Sciences and The Central Arkansas Veterans Healthcare System, Little Rock, Arkansas. Electronic address: https://twitter.com/MarwanSaadMD. 3. Division of Cardiovascular Medicine, University of Arkansas for Medical Sciences and The Central Arkansas Veterans Healthcare System, Little Rock, Arkansas. 4. Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota; Hennepin Healthcare, Minneapolis, Minnesota. 5. Aston Medical School, School of Medical Sciences, Aston University, Birmingham, United Kingdom. 6. Department of Medicine, Creighton University, Omaha, Nebraska. 7. Lancashire Cardiac Center, Blackpool Victoria Hospital, Blackpool, United Kingdom. 8. Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts. Electronic address: https://twitter.com/DLBHATTMD. 9. Division of Cardiovascular Medicine, The Warren Alpert Medical School of Brown University and Lifespan Cardiovascular Institute, Providence, Rhode Island. Electronic address: https://twitter.com/herbaronowMD. 10. Division of Cardiovascular Medicine, The Warren Alpert Medical School of Brown University and Lifespan Cardiovascular Institute, Providence, Rhode Island. Electronic address: https://twitter.com/JDawnAbbott1. 11. Division of Cardiovascular Medicine, University of Arkansas for Medical Sciences and The Central Arkansas Veterans Healthcare System, Little Rock, Arkansas. Electronic address: MehtaJL@uams.edu.
Abstract
BACKGROUND: The efficacy and safety of aspirin for primary prevention of cardiovascular disease (CVD) remain debatable. OBJECTIVES: The purpose of this study was to examine the clinical outcomes with aspirin for primary prevention of CVD after the recent publication of large trials adding >45,000 individuals to the published data. METHODS: Randomized controlled trials comparing clinical outcomes with aspirin versus control for primary prevention with follow-up duration of ≥1 year were included. Efficacy outcomes included all-cause death, cardiovascular (CV) death, myocardial infarction (MI), stroke, transient ischemic attack (TIA), and major adverse cardiovascular events. Safety outcomes included major bleeding, intracranial bleeding, fatal bleeding, and major gastrointestinal (GI) bleeding. Random effects DerSimonian-Laird risk ratios (RRs) for outcomes were calculated. RESULTS: A total of 15 randomized controlled trials including 165,502 participants (aspirin n = 83,529, control n = 81,973) were available for analysis. Compared with control, aspirin was associated with similar all-cause death (RR: 0.97; 95% confidence interval [CI]: 0.93 to 1.01), CV death (RR: 0.93; 95% CI: 0.86 to 1.00), and non-CV death (RR: 0.98; 95% CI: 0.92 to 1.05), but a lower risk of nonfatal MI (RR: 0.82; 95% CI: 0.72 to 0.94), TIA (RR: 0.79; 95% CI: 0.71 to 0.89), and ischemic stroke (RR: 0.87; 95% CI: 0.79 to 0.95). Aspirin was associated with a higher risk of major bleeding (RR: 1.5; 95% CI: 1.33 to 1.69), intracranial bleeding (RR: 1.32; 95% CI: 1.12 to 1.55), and major GI bleeding (RR: 1.52; 95% CI: 1.34 to 1.73), with similar rates of fatal bleeding (RR: 1.09; 95% CI: 0.78 to 1.55) compared with the control subjects. Total cancer and cancer-related deaths were similar in both groups within the follow-up period of the study. CONCLUSIONS: Aspirin for primary prevention reduces nonfatal ischemic events but significantly increases nonfatal bleeding events.
BACKGROUND: The efficacy and safety of aspirin for primary prevention of cardiovascular disease (CVD) remain debatable. OBJECTIVES: The purpose of this study was to examine the clinical outcomes with aspirin for primary prevention of CVD after the recent publication of large trials adding >45,000 individuals to the published data. METHODS: Randomized controlled trials comparing clinical outcomes with aspirin versus control for primary prevention with follow-up duration of ≥1 year were included. Efficacy outcomes included all-cause death, cardiovascular (CV) death, myocardial infarction (MI), stroke, transient ischemic attack (TIA), and major adverse cardiovascular events. Safety outcomes included major bleeding, intracranial bleeding, fatal bleeding, and major gastrointestinal (GI) bleeding. Random effects DerSimonian-Laird risk ratios (RRs) for outcomes were calculated. RESULTS: A total of 15 randomized controlled trials including 165,502 participants (aspirin n = 83,529, control n = 81,973) were available for analysis. Compared with control, aspirin was associated with similar all-cause death (RR: 0.97; 95% confidence interval [CI]: 0.93 to 1.01), CV death (RR: 0.93; 95% CI: 0.86 to 1.00), and non-CV death (RR: 0.98; 95% CI: 0.92 to 1.05), but a lower risk of nonfatal MI (RR: 0.82; 95% CI: 0.72 to 0.94), TIA (RR: 0.79; 95% CI: 0.71 to 0.89), and ischemic stroke (RR: 0.87; 95% CI: 0.79 to 0.95). Aspirin was associated with a higher risk of major bleeding (RR: 1.5; 95% CI: 1.33 to 1.69), intracranial bleeding (RR: 1.32; 95% CI: 1.12 to 1.55), and major GI bleeding (RR: 1.52; 95% CI: 1.34 to 1.73), with similar rates of fatal bleeding (RR: 1.09; 95% CI: 0.78 to 1.55) compared with the control subjects. Total cancer and cancer-related deaths were similar in both groups within the follow-up period of the study. CONCLUSIONS:Aspirin for primary prevention reduces nonfatal ischemic events but significantly increases nonfatal bleeding events.
Authors: Russell V Luepker; Niki C Oldenburg; Jeffrey R Misialek; Jeremy R Van't Hof; John R Finnegan; Milton Eder; Sue Duval Journal: Am J Prev Med Date: 2021-02-03 Impact factor: 5.043