Long considered an essential agent for primary cardiovascular disease prevention, aspirin has been getting a second look. In recent years, a growing number of trials and meta-analyses are questioning whether an aspirin a day is a good idea for primary-prevention populations.
Racial disparities persist in the use of aspirin for the primary prevention of coronary heart disease, new data from MESA show. And although guidance on the use of aspirin for primary prevention is now less clear-cut than when this study was performed, that doesn't change the overall message, say the authors.
A new statement from the AHA, ACC, and ADA says that aspirin for the primary prevention of cardiovascular disease is "reasonable" in patients with diabetes who are at high risk for cardiovascular events. The new recommendations are more cautious than those previously published.
This latest meta-analysis adds in the JPAD, POPADAD, and AAA trials to the 2009 Aspirin Treatment Trialists' Collaboration and reached very similar conclusions: aspirin's benefits in primary prevention are modest and substantially offset by its risks.
Authors of the study say their study does not rule out a role for ankle/brachial index screening in the clinic or for other CVD drugs to reduce risk in asymptomatic subjects. But for aspirin and for populationwide screening, the study raises some questions.
A new registry analysis should remind physicians to step up use of aspirin in patients proven to benefit but also gives a snapshot of aspirin use in primary prevention that may prove helpful when results come in from the large trials in this group.
In new guidelines from the American Diabetes Association, elevated glycosylated hemoglobin can, for the first time, suffice for a diagnosis of diabetes; the recommendations also tighten up on the age criteria for prescribing aspirin for primary prevention.
The year kicked off with some rosy recommendations from the USPSTF, but a steady accumulation of studies suggest that aspirin's risks may eclipse its benefits in preventing initial cardiac and cerebrovascular eventsmost strikingly, a report from the same group that bolstered the primary-prevention case for aspirin in the first place. Everyone agrees: it's time to talk to your patients about aspirin.
Most guideline documents recommend aspirin for primary prevention in people with diabetes, but a new meta-analysis has found no benefit of the widely used drug across a range of different cardiovascular end points. The results speak to the need for dedicated randomized trials, investigators say.
Not all patients with type 2 diabetes respond in the same way to aspirin, and its routine use in the primary prevention of cardiovascular events in this population needs careful evaluation in large randomized controlled trials, experts say.
The routine use of aspirin for the prevention of vascular events in the general population deemed at risk because of an abnormal ABI is not warranted, as the danger of bleeding outweighs any potential benefit.
A meta-analysis of trials assessing the effects of aspirin with or without dipyridamole in patients with PAD finds no significant benefit in reducing overall cardiovascular events, although there was a significant reduction in stroke as a secondary end point.
Low-dose aspirin didn't cut the risk of cardiovascular events but may have reduced CV mortality, a secondary end point, in the randomized but open-label trial conducted in Japan; clinical events were unexpectedly few, compromising the study's statistical power. (Ogawa H et al. JAMA 2008; 300:2180-2181.American Heart Association 2008 Scientific Sessions.)
A new study, POPADAD, has found no evidence that aspirin or antioxidants are of any benefit in the primary prevention of cardiovascular events in diabetic patients with asymptomatic peripheral arterial disease. The authors and accompanying editorialist say guidelines should be changed; others say more evidence is needed. (Belch Jet al. BMJ; published online before print October 16, 2008.)
A meta-analysis combining 23 trials indicates that aspirin reduces the risk of nonfatal MI but not fatal MI. Risk reduction was greater in trials dominated by men, whereas in studies in which one-third of the participants were women, aspirin had no significant effects on MI risk. (Yerman T et al. BMC Med 2007; 5:29.)
Currently available clinical data do not support the routine long-term use of aspirin dosages greater than 75 to 81 mg/day in the setting of cardiovascular disease prevention, a new review confirms. (Campbell CL et al. JAMA 2007; 297:2018-2024.)
Researchers did a cost-effectiveness study of aspirin for the primary prevention of CVD events in women and found that it costs $13 000 for each additional quality-adjusted life-year for an older woman. However, for the younger ages, the QALY was up to $50 000 and the risk of harm exceeded potential benefits. (Pignone M et al. Arch Intern Med 2007; 167:290-295.)
A sex-specific meta-analysis of aspirin for primary prevention has found that it reduces the risk of ischemic stroke in women, but not men, and MI in men, but not women. However, there is a price to pay in the form of increased bleeding for both sexes, and the decision on whether to give aspirin for primary prevention should be made on a case-by-case basis, say the researchers. (Berger JS et al. JAMA 2006; 295:306-313.)
The latest publication of this landmark study shows no overall effect of aspirin or vitamin E in the primary prevention of cancer and no effect of vitamin E in the primary prevention of cardiovascular disease. There was, however, the suggestion of a protective effect of aspirin against lung cancer. (Cook NR et al. Lee IM et al. JAMA 2005; 294:47-55, 56-65.)
Drs Peter Elwood and Colin Baigent debate the rationale for daily aspirin in older adults with no known disease, as well as the shortcomings of such a strategy. (Elwood P et al. Baigent C. BMJ 2005; 330:1440-1443.)
A new epidemiological modeling study finds that the benefits of aspirin for primary prevention of cardiovascular disease in the elderly are likely offset by the risks of therapy. A prospective trial is thus needed in this age group to establish whether aspirin is beneficial or not, say the researchers. (Nelson M et al. BMJ 2005; published online before print May 19, 2005.)
The Women's Health Study trial is formally published while debate rumbles on about why it failed to show a benefit of aspirin in primary prevention. (Ridker PM et al. N Eng J Med 2005; 352: 1293-1304.)
Following the unexpected finding from the Women's Health Study that aspirin for primary prevention does not lower the risk of myocardial infarction or cardiovascular death in women, experts tried to make sense of the data. (American College of Cardiology 2005 Scientific Sessions.)