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Association of Aspirin Use For Primary Prevention With Cardiovascular Events and Bleeding Eventsa Systematic Review and Meta-Analysis

This document summarizes a systematic review and meta-analysis of 13 randomized clinical trials with over 164,000 participants without cardiovascular disease. The analysis found that aspirin use was associated with a lower risk of cardiovascular events like heart attack and stroke, but also an increased risk of major bleeding events.

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33 views3 pages

Association of Aspirin Use For Primary Prevention With Cardiovascular Events and Bleeding Eventsa Systematic Review and Meta-Analysis

This document summarizes a systematic review and meta-analysis of 13 randomized clinical trials with over 164,000 participants without cardiovascular disease. The analysis found that aspirin use was associated with a lower risk of cardiovascular events like heart attack and stroke, but also an increased risk of major bleeding events.

Uploaded by

mirzero
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Association of Aspirin Use for

Primary Prevention With


Cardiovascular Events and
Bleeding EventsA Systematic
Review and Meta-analysis
Sean L. Zheng, BM, BCh, MA, MRCP1,2,3; Alistair J. Roddick, BSc3

Author Affiliations
JAMA. 2019;321(3):277-287. doi:10.1001/jama.2018.20578

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FullText

Key Points
Question What is the association of aspirin use with cardiovascular
events and bleeding events in individuals without cardiovascular
disease?

Findings In this meta-analysis of 13 trials with 164 225 participants


without cardiovascular disease, aspirin use was associated with a
lower risk of cardiovascular events, defined as cardiovascular death,
nonfatal myocardial infarction, and nonfatal stroke (hazard ratio [HR],
0.89; absolute risk reduction, 0.38%) and an increased risk of major
bleeding (HR, 1.43; absolute risk increase, 0.47%).

Meaning In individuals without cardiovascular disease, the use of


aspirin was associated with a lower risk of cardiovascular events and
an increased risk of major bleeding.
Abstract
Importance The role for aspirin in cardiovascular primary prevention
remains controversial, with potential benefits limited by an increased
bleeding risk.

Objective To assess the association of aspirin use for primary


prevention with cardiovascular events and bleeding.

Data Sources PubMed and Embase were searched on Cochrane


Library Central Register of Controlled Trials from the earliest available
date through November 1, 2018.

Study Selection Randomized clinical trials enrolling at least 1000


participants with no known cardiovascular disease and a follow-up of
at least 12 months were included. Included studies compared aspirin
use with no aspirin (placebo or no treatment).

Data Extraction and Synthesis Data were screened and extracted


independently by both investigators. Bayesian and frequentist meta-
analyses were performed.

Main Outcomes and Measures The primary cardiovascular outcome


was a composite of cardiovascular mortality, nonfatal myocardial
infarction, and nonfatal stroke. The primary bleeding outcome was any
major bleeding (defined by the individual studies).

Results A total of 13 trials randomizing 164 225 participants with


1 050 511 participant-years of follow-up were included. The median age
of trial participants was 62 years (range, 53-74), 77 501 (47%) were
men, 30 361 (19%) had diabetes, and the median baseline risk of the
primary cardiovascular outcome was 9.2% (range, 2.6%-15.9%). Aspirin
use was associated with significant reductions in the composite
cardiovascular outcome compared with no aspirin (57.1 per 10 000
participant-years with aspirin and 61.4 per 10 000 participant-years
with no aspirin) (hazard ratio [HR], 0.89 [95% credible interval, 0.84-
0.95]; absolute risk reduction, 0.38% [95% CI, 0.20%-0.55%]; number
needed to treat, 265). Aspirin use was associated with an increased
risk of major bleeding events compared with no aspirin (23.1 per
10 000 participant-years with aspirin and 16.4 per 10 000 participant-
years with no aspirin) (HR, 1.43 [95% credible interval, 1.30-1.56];
absolute risk increase, 0.47% [95% CI, 0.34%-0.62%]; number needed
to harm, 210).

Conclusions and Relevance The use of aspirin in individuals without


cardiovascular disease was associated with a lower risk of
cardiovascular events and an increased risk of major bleeding. This
information may inform discussions with patients about aspirin for
primary prevention of cardiovascular events and bleeding.

Editorial

Clinical Considerations for Aspirin Use for Primary Prevention in 2019

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