Aspirin: no primary prevention benefit with higher ASCVD risk, either

  • Nudy M & al.
  • Am J Med
  • 01.09.2020

  • von Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • Major bleeding risk with aspirin eclipses any primary prevention benefit in atherosclerotic cardiovascular disease (ASCVD), even in people with high risk.
  • The results of this meta-analysis do not support the idea that aspirin might still offer some benefit in higher-risk groups.

Why this matters

  • The authors say that other primary prevention therapies are as good as or better than aspirin without the bleeding risk.

Key results

  • They included 12 randomized controlled trials (n=145,435) comparing aspirin with placebo or control in primary ASCVD prevention.
  • Bias risk across trials was low-moderate.
  • Mean follow-up was 6.8 years.
  • Aspirin dose: range, 75-500 mg.
  • With vs without aspirin, ASCVD events per 1000 patient years:
    • 4.7 vs 5.3.
    • Rate ratio: 0.86 (95% CI, 0.79-0.92).
  • Heterogeneity for trials assessing ASCVD events was modest (I2=34%).
  • Aspirin had a greater treatment effect in older trials.
  • However, major bleeding events per 1000 patient years were increased with aspirin vs without:
    • 2.5 vs 1.8.
    • Rate ratio: 1.41 (95% CI, 1.29-1.54).
  • Heterogeneity for trials assessing major bleeding was low (I2=0%).

Study design

  • Meta-analysis of randomized controlled trials.
  • Funding: None.

Limitations

  • Included some older studies; primary prevention approaches and lifestyle factors (e.g., smoking) have changed.