University of Oklahoma Health Sciences Center

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Author/s:

Murphy, Sean, McCarthy, Cian P., McEvoy, John W.

Date Added:

March 18, 2019

Journal/Publication:

The American Journal of Medicine

Publisher:

Elsevier

Publication Date:

March 12, 2019

URL:

Aspirin for the Primary Prevention of Cardiovascular Disease: Weighing Up the Evidence

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1016/j.amjmed.2019.02.025

PMID (1):

30871925

Keywords

aspirin

cardiovascular events

MeSH

cardiovascular diseases

aspirin

primary prevention

secondary prevention

RPR Commentary

A nice review of the effectiveness of aspirin for primary prevention of CV events with a particular focus on the question of weight-based dosing. Bottom line is that primary prevention of CV events with aspirin, regardless of dose, is rarely justifiable.

Abstract

Aspirin is one of the most universally recognized and commonly prescribed medications worldwide. It is estimated that 48.7 million U.S. adults are taking aspirin for cardiovascular disease prevention; the majority (~73%) for primary prevention. The benefit of aspirin for secondary prevention of cardiovascular disease is well-established, with meta-analysis results favoring low dose (75–150 mg/day) over high dose (>150 mg/day) aspirin given similar efficacy but lower bleeding risk. In contrast, the role of aspirin in primary cardiovascular disease prevention is more controversial; historical trials found benefit but trials since 2008 have shown either null effects on all-cause and cardiovascular disease mortality or a signal for increased mortality in the context of excess bleeding.

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