Key result
Aspirin for primary cardiovascular disease prevention yields a modest reduction in ischemic events that is offset by a modest increase in nonfatal bleeding, resulting in a neutral net benefit.
Why the study?
While aspirin's merits in secondary prevention are clear, its role in primary prevention is controversial following three recent trials reporting neutral net benefit or harm in patients with no overt CVD.
Does aspirin prevent cardiovascular events in patients with no overt cardiovascular disease?
Does aspirin prevent cardiovascular events in patients with no overt cardiovascular disease?
In contemporary practice, the modest ischemic benefit of aspirin for primary prevention is offset by increased bleeding risk, making routine use unfavorable.
Does not support routine aspirin for primary prevention; leaves open refined use amid better risk factor control or in select subgroups.
Introduction: While the clinical merits of aspirin in secondary cardiovascular disease (CVD) prevention remain undisputed, its role in primary prevention is controversial. Recently, three trials of primary prevention reported neutral net benefit results or evidence of harm for aspirin in patients with no overt CVD.Areas covered: This article aims to inform clinical practitioners by appraising the current body of evidence on the use of aspirin for primary CVD prevention, ranging from general pharmacology to clinical outcomes and future directions.Expert opinion: Based on meta-analyses incorporating latest trials in the field of primary prevention, the modest reduction in ischemic events with aspirin, if any, is offset by a modest increase in nonfatal bleeding. Improved control of CVD risk factors and broader use of statins may have reduced the thrombotic complications of atherosclerosis, thus limiting the opportunity for aspirin to prevent clinical CVD events in the contemporary era. As such, decision-making about aspirin for primary prevention is challenging even when selected patients are considered and involves careful weighing of risks and benefits. Ongoing investigations conducted in patients with cancer could rapidly modify the current perception of the unfavorable benefit-risk ratio of aspirin in patients with no overt CVD.
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Capodanno et al. (2019) conducted a review in Cardiovascular disease. Aspirin was evaluated. Aspirin for primary cardiovascular disease prevention yields a modest reduction in ischemic events that is offset by a modest increase in nonfatal bleeding, resulting in a neutral net benefit.
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