Aspirin CVD primary prevention doubt
Researchers caution against the use of aspirin for primary prevention of cardiovascular disease (CVD), after their meta-analysis demonstrated that any benefit is offset by the increased risk for bleeding among patients without a history of the disease.
"Routine use of aspirin for primary prevention is not warranted and treatment decisions need to be considered on a case-by-case basis," report Dr Sreenivasa Seshasai (St George's University of London) and co-authors in the Archives of Internal Medicine.
Their review of nine randomised placebo-controlled trials, involving over 100,000 participants, showed that aspirin treatment reduced the risk of CVD events by 10% over the 6-year follow-up, giving a number needed to treat of 120.
On the other hand, there was no significant reduction in CVD death or cancer mortality.
And there was a significant 31% increase in the risk for non-trivial bleeding events (fatal from any site, cerebrovascular or retinal, from hollow viscus, requiring hospitalization and/or transfusion, or major regardless of source), giving a number needed to harm of 73.
In a related commentary, Dr Samia Mora (Harvard Medical School, Boston, Massachusetts, USA) argues that "it is reasonable to consider using aspirin for primary prevention in higher-risk individuals without known CVD (above 1% CVD event rate per year) if they are deemed to have a greater benefit-to-risk ratio and after taking into account patient preferences".
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By MedWire Reporters