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

Kód výsledku v 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>

Výsledek na webu

<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>

Jazyk výsledku

angličtina

Název v původním jazyce

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

Popis výsledku v původním jazyce

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.

Název v anglickém jazyce

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

Popis výsledku anglicky

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.

Druh

J_imp - Článek v periodiku v databázi Web of Science

CEP obor

—

OECD FORD obor

30201 - Cardiac and Cardiovascular systems

Projekt

—

Návaznosti

I - Institucionalni podpora na dlouhodoby koncepcni rozvoj vyzkumne organizace

Rok uplatnění

2019

Kód důvěrnosti údajů

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

Název periodika

BMC Medicine

ISSN

1741-7015

e-ISSN

—

Svazek periodika

17

Číslo periodika v rámci svazku

1

Stát vydavatele periodika

GB - Spojené království Velké Británie a Severního Irska

Počet stran výsledku

16

Strana od-do

198

Kód UT WoS článku

000494722900001

EID výsledku v databázi Scopus

2-s2.0-85074394065