Aspirin for primary prevention of cardiovascular disease: new review

  • Abdelaziz HK & al.
  • J Am Coll Cardiol
  • 18 Jun 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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  • Aspirin use for primary prevention reduced the risk for non-fatal ischaemic events and increased the risk for non-fatal bleeding events.
  • The benefits were more pronounced when atherosclerotic cardiovascular disease (ASCVD) risk was ≥7.5% over 10 years.

Why this matters

  • Findings suggest that the decision to use aspirin for primary prevention should be based on patient’s ASCVD and bleeding risk and patient preferences regarding types of events prevented vs potential bleeding caused.

Study design

  • 15 randomised controlled trials (n=165,502) that compared the effects of aspirin (n=83,529) vs control (n=81,973) for primary prevention of cardiovascular (CV) disease with ≥1 year of follow-up were included.
  • Efficacy outcomes: all-cause death, CV death, myocardial infarction (MI), stroke, transient ischaemic attack (TIA) and major adverse cardiovascular events (MACEs; non-fatal MI, non-fatal stroke, TIA and CV death).
  • Safety outcomes: major, intracranial, fatal and major gastrointestinal (GI) bleeding.
  • Funding: None disclosed.

Key results

  • Aspirin vs control group did not differ in:
    • all-cause death (risk ratio [RR], 0.97; 95% CI, 0.93-1.01; P=.13),
    • CV death (RR, 0.93; 95% CI, 0.86-1.00; P=.064),
    • non-CV death (RR, 0.98; 95% CI, 0.92-1.05; P=.53), and
    • fatal bleeding (RR, 1.09; 95% CI, 0.78-1.55; P=.6).
  • The risks for non-fatal MI (RR, 0.82; 95% CI, 0.72-0.94; P=.005; I2, 58%), TIA (RR, 0.79; 95% CI, 0.71-0.89; P<.001 maces ci p=".001)" and ischaemic stroke were significantly lower in aspirin vs control group.>
  • Aspirin vs control group was associated with a significantly higher risk for:
    • major (RR, 1.50; 95% CI, 1.33-1.69; P<.001>
    • intracranial (RR, 1.32; 95% CI, 1.12-1.55; P=.001), and
    • major GI (RR, 1.52; 95% CI, 1.34-1.73; P<.001 bleeding.>


  • Heterogeneity among studies.