Benefit of Aspirin in Primary Prevention Questioned

Despite reduction in nonfatal MIs, no reduction seen in cardiovascular death or cancer mortality

TUESDAY, Jan. 10 (HealthDay News) -- For individuals without prior cardiovascular disease (CVD), aspirin prophylaxis does not reduce cardiovascular death or cancer mortality, although it is associated with reductions in nonfatal myocardial infarction (MI), according to a meta-analysis published online Jan. 9 in the Archives of Internal Medicine.

Sreenivasa Rao Kondapally Seshasai, M.D., from St. George's University of London, and colleagues reviewed available literature to evaluate the impact and safety of aspirin on vascular and nonvascular outcomes in primary prevention. Nine randomized placebo-controlled trials, each comprising at least 1,000 participants, were included. CVD risk reductions were compared with increases in bleeding to assess the risks versus benefits for aspirin.

The investigators found that, during follow-up of more than 100,000 participants over a mean of six years, there was a 10 percent reduction in total CVD events associated with aspirin treatment (odds ratio [OR], 0.9). This was mainly due to a reduction in nonfatal MI (odds ratio, 0.80), with no significant reduction seen in CVD death (OR, 0.99; 95 percent confidence interval [CI], 0.85 to 1.15) or cancer mortality (OR, 0.93; 95 percent CI, 0.84 to 1.03). There was a significant increase in the risk of nontrivial bleeding events (OR, 1.31; 95 percent CI, 1.14 to 1.50).

"Because the benefits of aspirin treatment were accompanied by a significant increase in risk of bleeding, further study is needed to identify subsets of participant having favorable risk to benefit ratio for aspirin use in primary prevention," the authors write.

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