The authors of a new meta-analysis examined data from nine randomized controlled trials in which patients received aspirin for the primary prevention of cardiovascular disease. The studies involved a total of 102,621 participants. The mean age at baseline was 57 years, and 46% of the patients were male. The mean duration of follow-up was six years, during which 2,169 coronary heart disease-related events occurred, as well as 1,504 strokes and 4,279 cardiovascular disease-related events.

There was a 10% reduction in the risk of cardiovascular disease-related events in patients who received aspirin, a statistic bloated by a 20% drop in the risk of nonfatal myocardial infarction; in actuality, no benefit was noted in terms of the rates of fatal myocardial infarction, stroke, or death related to cardiovascular disease, and only small, nonsignificant reductions were seen in rates of overall coronary heart disease, nonvascular mortality, and all-cause mortality. Aspirin therapy also didn't reduce cancer mortality. Of particular concern are the 70% increase in the risk of bleeding events and the more than 30% higher risk of "nontrivial" bleeding events seen in the patients receiving aspirin.

Based on these findings, the authors conclude that aspirin doesn't offer protection against fatal myocardial infarction, stroke, or cardiovascular disease-related death and that the benefit related to nonfatal myocardial infarction is neutralized by the increased risk of bleeding. They suggest that additional studies be undertaken to determine subsets of patients in whom the use of preventative aspirin confers greater benefit than risk. In addition, the common practice of prescribing daily aspirin for primary prevention of cardiovascular disease in healthy adults should be reevaluated.-SDSJ

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