January 15, 2002Annals of Internal Medicine
Aspirin for the Primary Prevention of Cardiovascular Events: A Summary of the Evidence for the U.S. Preventive Services Task Force
Key result
Aspirin chemoprevention in patients without known cardiovascular disease reduces the risk of nonfatal myocardial infarction and fatal coronary heart disease (OR 0.72; 95% CI 0.60-0.87).
Why the study?
Does aspirin chemoprevention reduce the combined end point of nonfatal myocardial infarction and fatal coronary heart disease in patients without previously known cardiovascular disease?
Population
Patients without previously known cardiovascular disease (5 trials)
Design
Meta-analysis
Follow-up
at least 1 year
Authors
Discussion
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Overview
Supports targeted aspirin use in higher-risk primary prevention; confirms MI/CHD benefit while underscoring individualized bleeding risk assessment.
Key Points
- To evaluate the benefits and harms of aspirin for primary prevention of cardiovascular events in individuals without known cardiovascular disease.
- Included randomized trials at least 1 year in duration and systematic reviews related to aspirin use.
- Data extraction by one reviewer and verification by a second reviewer with consensus for discrepancies.
- Conducted a meta-analysis to model consequences of aspirin treatment based on different baseline cardiovascular risks.
- Aspirin reduced nonfatal myocardial infarction and fatal coronary heart disease (summary odds ratio 0.72, 95% CI 0.60 to 0.87).
- Aspirin increased hemorrhagic stroke risk (summary odds ratio 1.4, 95% CI 0.9 to 2.0) and major gastrointestinal bleeding (summary odds ratio 1.7, 95% CI 1.4 to 2.1).
- Net benefits of aspirin increase with higher cardiovascular risk, with greater prevention of myocardial infarctions than strokes or bleeding events.
Study Design
Type
Meta-Analysis
Structured PICO
Does aspirin chemoprevention reduce the combined end point of nonfatal myocardial infarction and fatal coronary heart disease in patients without previously known cardiovascular disease?
P
Population
Patients without previously known cardiovascular disease (5 trials)
I
Intervention
Aspirin chemoprevention
O
Outcome
Combined end point of nonfatal myocardial infarction and fatal coronary heart diseasecomposite
Main Result
Effect estimate: OR 0.72 (95% CI 0.60-0.87)
Aspirin for primary prevention reduces nonfatal MI and fatal CHD but increases hemorrhagic stroke and major GI bleeding, meaning net benefit depends on baseline cardiovascular risk.
Cite This Study
Hayden et al. (2002) conducted a meta-analysis in Primary prevention of cardiovascular events. Aspirin was evaluated on combined end point of nonfatal myocardial infarction and fatal coronary heart disease (OR 0.72, 95% CI 0.60-0.87). Aspirin chemoprevention in patients without known cardiovascular disease reduces the risk of nonfatal myocardial infarction and fatal coronary heart disease (OR 0.72; 95% CI 0.60-0.87).