Key result
Low-dose aspirin for primary prevention reduces MI and stroke but increases major GI bleeding ~58%.
Why the study?
Recent articles and updates to clinical guidelines for the primary prevention of CVD have resulted in confusion regarding recommendations for aspirin therapy.
Effect estimate: OR 1.58 (95% CI 1.38-1.80)
Low-dose aspirin for primary CVD prevention should be highly individualized, targeting adults aged 40-59 with high ASCVD risk and low bleeding risk, while avoiding routine use in older adults.
Reinforces individualized aspirin decisions in primary prevention; leaves open need for updated RCTs in contemporary populations.
Cardiovascular disease (CVD), including coronary artery disease and stroke, is the leading cause of death worldwide. Advances in primary and secondary prevention of CVD have improved patient prognoses and outcomes, however, it is imperative that the clinician and patient engage in early risk factor screening and preventive management of modifiable risk factors for CVD. In addition to blood lipid and blood pressure lowering medications, aspirin has been a long-standing therapy targeted to the prevention of CVD based on its antiplatelet and anti-inflammatory activity. However, recent articles and reports on updates to clinical guidelines for the primary prevention of CVD have resulted in confusion about aspirin recommendations. This review aims to assess the latest guidance on aspirin in CVD prevention and how to identify appropriately at-risk patients who may benefit from low-dose aspirin therapy as part of their CVD preventive healthcare choices. Additionally, this review will provide practical application guidance about clinician-patient conversations to clearly explain the benefits and risks of aspirin use and ensure a patient-centric decision to initiate aspirin therapy.
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Weisman et al. (2024) conducted a review in Cardiovascular Disease (n=161,680). Aspirin vs. Placebo/No aspirin was evaluated on Major GI bleeding (OR 1.58, 95% CI 1.38-1.80). Low-dose aspirin for primary prevention of cardiovascular disease reduces MI and stroke risk but increases the risk of major gastrointestinal bleeding by 58% (OR 1.58).
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