Aspirin uncertainty: MI risk reduction seen but not much else

  • Ther Clin Risk Manag

  • von Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • Aspirin is associated with reduced myocardial infarction (MI) risk in patients without cardiovascular disease (CVD), but not much else in the way of primary prevention benefit.
  • This meta-analysis confirms recent findings of limited benefits and increased risks for bleeding and stroke.

Why this matters

  • These authors suggest that the bleeding risks largely outweigh any CVD benefits for people with low to moderate CVD risk.
  • That is in keeping with a recent study showing a positive benefit-risk balance among older people only for those with highest risk.

Key results

  • These authors detected little study bias, and typically low study heterogeneity except for MI and gastrointestinal bleeding.
  • The only risk reduction with aspirin was seen for MI: risk ratio (RR), 0.83 (95% CI, 0.73-0.95; P=.005).
  • No risk reductions were seen for all-cause (0.97; P=.266) or cardiovascular mortality (0.93; P=.096) or stroke (0.95; P=.208).
  • Aspirin use was associated with increased risk (RRs; 95% CIs) for:
    • Major bleeding: 1.40 (1.25-1.57; P=.000).
    • Gastrointestinal bleeding: 1.58 (1.25-1.99; P=.000).
    • Hemorrhagic stroke: 1.30 (1.06-1.60; P=.011).

Study design

  • Meta-analysis of 14 studies, including 3 recent trials, with 139,392 participants aged 55-74 years, without CVD, mostly receiving low-dose aspirin (81 or 100 mg/day), with follow-up of 4-10 years.

Limitations

  • Some studies are more than a decade old.
  • Some demographic information was not available.