Atherosclerosis: aspirin may be useful among patients with a prior ischaemic event

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  • In outpatients with stable atherosclerosis, aspirin use was marginally beneficial only among patients with atherosclerosis with a prior ischaemic event.

Why this matters

  • Although not well studied, aspirin has been assumed to be of benefit and recommended in all forms of atherosclerosis, including those without a prior ischaemic event.

Study design

  • Participants from the Reduction of Atherothrombosis for Continued Health (REACH) registry were followed prospectively for up to 4 y.
  • Patients were divided according to prior ischaemic event (n=21,724) vs stable atherosclerosis, but no prior ischaemic event (n=11,872).
  • Primary outcome was the first occurrence of cardiovascular death, myocardial infarction (MI) or stroke.
  • Funding: None disclosed.

Key results

  • At a median of 41 mo, the risk for occurrence of cardiovascular death, MI or stroke was marginally lower with aspirin users vs non-users (15.2% vs 15.8%; HR, 0.81; P=.06).
  • At a median of 36 mo, aspirin use was not associated with a lower risk for cardiovascular death, MI or stroke in the group without a prior ischaemic event (HR, 1.03; P=.86).


  • Lack of benefit of aspirin therapy among the atherosclerosis group reflects insufficient power to detect a difference in outcomes.
  • Outcomes in REACH were not adjudicated.