Effect of Aspirin on Mortality in the Primary Prevention of Cardiovascular Disease
American Journal of Medicine, 06/21/2011
Aspirin prevents deaths, myocardial infarction, and ischemic stroke, and increases hemorrhagic stroke and major bleeding when used in the primary prevention of cardiovascular disease.
Eligible articles were identified by searches of electronic databases and reference lists.
Outcomes of interest were all–cause mortality, cardiovascular mortality, myocardial infarction, stroke, and bleeding.
Data were pooled from individual trials using the DerSimonian–Laird random–effects model, and results are presented as relative risk (RR) and 95% confidence intervals (CIs).
Nine randomized controlled trials enrolling 100,076 participants were included.
Aspirin reduced all–cause mortality (RR 0.94; 95% CI, 0.88–1.00), myocardial infarction (RR 0.83; 95% CI, 0.69–1.00), ischemic stroke (RR 0.86; 95% CI, 0.75–0.98), and the composite of myocardial infarction, stroke, or cardiovascular death (RR 0.88; 95% CI, 0.83–0.94), but did not reduce cardiovascular mortality (RR 0.96; 95% CI, 0.84–1.09).
Aspirin increased the risk of hemorrhagic stroke (RR 1.36; 95% CI, 1.01–1.82), major bleeding (RR 1.66; 95% CI, 1.41–1.95), and gastrointestinal bleeding (RR 1.37; 95% CI, 1.15–1.62).
A lack of availability of patient–level data precluded exploration of benefits and risks of aspirin in key subgroups.