Aspirin for primary prevention of cardiovascular disease: A meta-analysis with a particular focus on subgroups

Result code in IS VaVaI

<a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F67985807%3A_____%2F19%3A00511513" target="_blank" >RIV/67985807:_____/19:00511513 - isvavai.cz</a>

Result on the web

<a href="http://hdl.handle.net/11104/0301761" target="_blank" >http://hdl.handle.net/11104/0301761</a>

DOI - Digital Object Identifier

<a href="http://dx.doi.org/10.1186/s12916-019-1428-0" target="_blank" >10.1186/s12916-019-1428-0</a>

Result language

angličtina

Original language name

Aspirin for primary prevention of cardiovascular disease: A meta-analysis with a particular focus on subgroups

Original language description

BACKGROUND: The role of aspirin in primary prevention of cardiovascular disease (CVD) remains unclear. We aimed to investigate the benefit-risk ratio of aspirin for primary prevention of CVD with a particular focus on subgroups. METHODS: Randomized controlled trials comparing the effects of aspirin for primary prevention of CVD versus control and including at least 1000 patients were eligible for this meta-analysis. The primary efficacy outcome was all-cause mortality. Secondary outcomes included cardiovascular mortality, major adverse cardiovascular events (MACE), myocardial infarction, ischemic stroke, and net clinical benefit. The primary safety outcome was major bleeding. Subgroup analyses involving sex, concomitant statin treatment, diabetes, and smoking were performed. RESULTS: Thirteen randomized controlled trials comprising 164,225 patients were included. The risk of all-cause and cardiovascular mortality was similar for aspirin and control groups (RR 0.98, 95% CI, 0.93-1.02, RR 0.99, 95% CI, 0.90-1.08, respectively). Aspirin reduced the relative risk (RRR) of major adverse cardiovascular events (MACE) by 9% (RR 0.91, 95% CI, 0.86-0.95), myocardial infarction by 14% (RR 0.86, 95% CI, 0.77-0.95), and ischemic stroke by 10% (RR 0.90, 95% CI, 0.82-0.99), but was associated with a 46% relative risk increase of major bleeding events (RR 1.46, 95% CI, 1.30-1.64) compared with controls. Aspirin use did not translate into a net clinical benefit adjusted for event-associated mortality risk (mean 0.034%, 95% CI,-0.18 to 0.25%). There was an interaction for aspirin effect in three patient subgroups: (i) in patients under statin treatment, aspirin was associated with a 12% RRR of MACE (RR 0.88, 95% CI, 0.80-0.96), and this effect was lacking in the no-statin group, (ii) in non-smokers, aspirin was associated with a 10% RRR of MACE (RR 0.90, 95% CI, 0.82-0.99), and this effect was not present in smokers, and (iii) in males, aspirin use resulted in a 11% RRR of MACE (RR 0.89, 95% CI, 0.83-0.95), with a non-significant effect in females. Conclusions: Aspirin use does not reduce all-cause or cardiovascular mortality and results in an insufficient benefit-risk ratio for CVD primary prevention. Non-smokers, patients treated with statins, and males had the greatest risk reduction of MACE across subgroups.

Czech name

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Czech description

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Type

J_imp - Article in a specialist periodical, which is included in the Web of Science database

CEP classification

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OECD FORD branch

30201 - Cardiac and Cardiovascular systems

Project

—

Continuities

I - Institucionalni podpora na dlouhodoby koncepcni rozvoj vyzkumne organizace

Publication year

2019

Confidentiality

S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů

Name of the periodical

BMC Medicine

ISSN

1741-7015

e-ISSN

—

Volume of the periodical

17

Issue of the periodical within the volume

1

Country of publishing house

GB - UNITED KINGDOM

Number of pages

16

Pages from-to

198

UT code for WoS article

000494722900001

EID of the result in the Scopus database

2-s2.0-85074394065