- Controversy over aspirin for primary cardiovascular (CV) disease prevention continues.
- Meta-analysis finds protection against CV events but increased major bleeding risk.
Why this matters
- Results follow on high-profile reports that aspirin does not keep CV disease at bay in older adults.
- 2 other major studies reached similar conclusions.
- They are all in agreement about the increased bleeding risk, however.
- Editorial: use of aspirin for primary prevention requires careful patient selection.
- With aspirin use vs no use, decreased risk for composite CV outcome:
- 57.1/10,000 vs 61.4/10,000 participant-years;
- HR, 0.89 (95% credible interval [CrI], 0.84-0.95);
- Absolute risk reduction, 0.38% (95% CI, 0.20%-0.55%);
- Number needed to treat, 265;
- Low heterogeneity: I2=0%; and
- Risk also decreased for ischemic stroke and myocardial infarction.
- With aspirin use vs no use, increased major bleeding risk:
- 23.1 vs 16.4/10,000 participant-years;
- HR, 1.43 (95% CrI, 1.30-1.56);
- Absolute risk increase, 0.47% (95% CI, 0.34%-0.62%); and
- Number needed to harm, 210.
- No reductions in all-cause, CV mortality with aspirin.
- Meta-analysis, 13 randomized trials; n=164,225; 1,050,511 participant-years of follow-up.
- Main outcomes: CV composite (mortality, nonfatal myocardial infarction, nonfatal stroke); major bleeding.
- Funding: None disclosed.
- Related to those of included trials.