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