Nicola Veronese1,2, Jacopo Demurtas3,4, Trevor Thompson5, Marco Solmi6, Gabriella Pesolillo7, Stefano Celotto8, Tommaso Barnini9, Brendon Stubbs10,11, Stefania Maggi1, Alberto Pilotto2, Graziano Onder12, Evropi Theodoratou13,14, Alberto Vaona15, Joseph Firth16,17, Lee Smith18, Ai Koyanagi19,20, John P A Ioannidis21,22,23,24, Ioanna Tzoulaki13,25. 1. National Research Council, Neuroscience Institute, Aging Branch, Padua, Italy. 2. Geriatrics Unit, Department of Geriatric Care, Ortho Geriatrics and Rehabilitation, Frailty Area, E.O. Galliera Hospital, Genoa, Italy. 3. Primary Care Department, Azienda USL Toscana Sud Est, Grosseto, Italy. 4. Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy. 5. Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, UK. 6. Department of Neuroscience, University of Padova, Padua, Italy. 7. Primary Care Service, ASL 02, Chieti, Italy. 8. Primary Care Department, Alto Friuli-Collinare-Medio Friuli, Udine, Italy. 9. Primary Care Service, AUSL Toscana Centro, Florence, Italy. 10. Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, UK. 11. Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, UK. 12. Fondazione Policlinico Universitario A. Gemelli, IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy. 13. Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK. 14. Edinburgh Cancer Research Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK. 15. Primary Care Department, Azienda ULSS20 Verona, Verona, Italy. 16. NICM Health Research Institute, University of Western Sydney, Penrith, Australia. 17. Division of Psychology and Mental Health, University of Manchester, Manchester, UK. 18. The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK. 19. Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain. 20. Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain. 21. Stanford Prevention Research Center, Department of Medicine, Stanford University Medical School, Stanford, California, USA. 22. Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California, USA. 23. Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, California, USA. 24. Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, California, USA. 25. MRC-PHE Centre for Environment, School of Public Health, Imperial College London, UK.
Abstract
AIMS: This study aimed to use an umbrella review methodology to capture the range of outcomes that were associated with low-dose aspirin and to systematically assess the credibility of this evidence. METHODS: Aspirin is associated with several health outcomes, but the overall benefit/risk balance related to aspirin use is unclear. We searched three major databases up to 15 August 2019 for meta-analyses of observational studies and randomized controlled trials (RCTs) including low-dose aspirin compared to placebo or other treatments. Based on random-effects summary effect sizes, 95% prediction intervals, heterogeneity, small-study effects and excess significance, significant meta-analyses of observational studies were classified from convincing (class I) to weak (class IV). For meta-analyses of RCTs, outcomes with random effects P-value < .005 and a moderate/high GRADE assessment, were classified as strong evidence. From 6802 hits, 67 meta-analyses (156 outcomes) were eligible. RESULTS: Observational data showed highly suggestive evidence for aspirin use and increased risk of upper gastrointestinal bleeding (RR = 2.28, 95% CI: 1.97-2.64). In RCTs of low-dose aspirin, we observed strong evidence for lower risk of CVD in people without CVD (RR = 0.83; 95% CI: 0.79-0.87) and in general population (RR = 0.83; 95% CI: 0.79-0.89), higher risk of major gastrointestinal (RR = 1.47; 95% CI: 1.26-1.72) and intracranial bleeding (RR = 1.34; 95% CI: 1.18-1.53), and of major bleedings in people without CVD (RR = 1.62; 95% CI: 1.26-2.08). CONCLUSION: Compared to other active medications, low-dose aspirin had strong evidence for lower risk of bleeding, but also lower comparative efficacy. Low-dose aspirin significantly lowers CVD risk and increases risk of bleeding. Evidence for multiple other health outcomes is limited.
AIMS: This study aimed to use an umbrella review methodology to capture the range of outcomes that were associated with low-dose aspirin and to systematically assess the credibility of this evidence. METHODS:Aspirin is associated with several health outcomes, but the overall benefit/risk balance related to aspirin use is unclear. We searched three major databases up to 15 August 2019 for meta-analyses of observational studies and randomized controlled trials (RCTs) including low-dose aspirin compared to placebo or other treatments. Based on random-effects summary effect sizes, 95% prediction intervals, heterogeneity, small-study effects and excess significance, significant meta-analyses of observational studies were classified from convincing (class I) to weak (class IV). For meta-analyses of RCTs, outcomes with random effects P-value < .005 and a moderate/high GRADE assessment, were classified as strong evidence. From 6802 hits, 67 meta-analyses (156 outcomes) were eligible. RESULTS: Observational data showed highly suggestive evidence for aspirin use and increased risk of upper gastrointestinal bleeding (RR = 2.28, 95% CI: 1.97-2.64). In RCTs of low-dose aspirin, we observed strong evidence for lower risk of CVD in people without CVD (RR = 0.83; 95% CI: 0.79-0.87) and in general population (RR = 0.83; 95% CI: 0.79-0.89), higher risk of major gastrointestinal (RR = 1.47; 95% CI: 1.26-1.72) and intracranial bleeding (RR = 1.34; 95% CI: 1.18-1.53), and of major bleedings in people without CVD (RR = 1.62; 95% CI: 1.26-2.08). CONCLUSION: Compared to other active medications, low-dose aspirin had strong evidence for lower risk of bleeding, but also lower comparative efficacy. Low-dose aspirin significantly lowers CVD risk and increases risk of bleeding. Evidence for multiple other health outcomes is limited.
Authors: Xue Li; Xiangrui Meng; Maria Timofeeva; Ioanna Tzoulaki; Konstantinos K Tsilidis; John PA Ioannidis; Harry Campbell; Evropi Theodoratou Journal: BMJ Date: 2017-06-07
Authors: Luis A García Rodríguez; Mar Martín-Pérez; Charles H Hennekens; Peter M Rothwell; Angel Lanas Journal: PLoS One Date: 2016-08-04 Impact factor: 3.240
Authors: Nicola Veronese; Jacopo Demurtas; Trevor Thompson; Marco Solmi; Gabriella Pesolillo; Stefano Celotto; Tommaso Barnini; Brendon Stubbs; Stefania Maggi; Alberto Pilotto; Graziano Onder; Evropi Theodoratou; Alberto Vaona; Joseph Firth; Lee Smith; Ai Koyanagi; John P A Ioannidis; Ioanna Tzoulaki Journal: Br J Clin Pharmacol Date: 2020-06-02 Impact factor: 4.335
Authors: Wolfgang Marx; Nicola Veronese; Jaimon T Kelly; Lee Smith; Meghan Hockey; Sam Collins; Gina L Trakman; Erin Hoare; Scott B Teasdale; Alexandra Wade; Melissa Lane; Hajara Aslam; Jessica A Davis; Adrienne O'Neil; Nitin Shivappa; James R Hebert; Lauren C Blekkenhorst; Michael Berk; Toby Segasby; Felice Jacka Journal: Adv Nutr Date: 2021-10-01 Impact factor: 8.701
Authors: Perrine Janiaud; Arnav Agarwal; Ioanna Tzoulaki; Evropi Theodoratou; Konstantinos K Tsilidis; Evangelos Evangelou; John P A Ioannidis Journal: BMC Med Date: 2021-07-06 Impact factor: 11.150