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.

Methods

  • 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).

Results

  • 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.

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