Although the benefits of aspirin use for the secondary prevention of cardiovascular disease are well established, its use in primary prevention remains controversial. A meta-analysis was undertaken to evaluate the association of aspirin use with cardiovascular and bleeding events in people who didn't have cardiovascular disease.

Researchers reviewed publications available through 2018, identifying randomized controlled studies that enrolled patients without a history of cardiovascular disease, compared aspirin use with no aspirin use, had a follow-up of at least 12 months, and enrolled more than 1,000 participants. Twenty-one articles reporting on 13 studies, with a total enrollment of 164,225 participants, were included in the analysis; 47.2% of participants were men, 18.5% had diabetes, and the median 10-year estimated cardiovascular event rate was 9.2%.

Use of aspirin, as compared with not using aspirin, was associated with reductions in the primary cardiovascular outcome, a composite of cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke. Aspirin use, however, was also associated with a higher risk of major bleeding, intracranial hemorrhage, and major gastrointestinal bleeding in patients with both low and high cardiovascular risks and in people with diabetes.

The authors suggest that their findings may help to inform discussions with patients about using aspirin for the primary prevention of cardiovascular events. They note several limitations of their study, including that the daily doses of aspirin and the definition of end points varied from study to study. Also, more primary prevention strategies are available now than when several of the reviewed studies were conducted.

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