Table 1.
Summarizing published evidence for or against a beneficial effect of aspirin in primary prevention of cardiovascular disease
| Study | Beneficial effects | No effect/harmful effects |
|---|---|---|
| The Antithrombotic Trialists’ Collaboration (ATTC) meta-analysis [6] | - A 12 % proportional reduction in serious vascular events, mainly due to a reduction in first nonfatal myocardial infarction | - No effect on stroke occurrence |
| - Increase in the risk of major gastrointestinal and other extracranial bleeding by about 50 % | ||
| - Small protective effect on mortality | - Increased incidence of hemorrhagic stroke (22 %) | |
| Seshasai et al. [9] | - Significant decrease in the risk of cardiovascular events (notably nonfatal myocardial infarction) | No effect on fatal myocardial infarction |
| - Modest non-significant reduction in all-cause mortality | ||
| He et al. [21] | Absolute risk reduction in myocardial infarction and ischemic stroke | Increased risk of hemorrhagic stroke |
| De Beradis et al. [23] | High incidence of major bleeding events with an overall incidence rate of hemorrhagic events (gastrointestinal and intracranial bleeding episodes) | |
| The Japanese Primary Prevention Project (JPPP) [24] | - Significant reduction in the incidence of nonfatal myocardial infarction | - No significant diminution in the risk of the composite outcome of cardiovascular death, nonfatal stroke, and nonfatal myocardial infarction |
| - Significant reduction in the incidence of transient ischemic attack | ||
| - Increase in the risk of extracranial hemorrhage requiring transfusion or hospitalization | ||
| The Multi-Ethnic Study of Atherosclerosis [27] | Estimated 2–4 fold increased likelihood to prevent a heart attack with aspirin use than to have a major bleed secondary to aspirin in participants with significant plaque in their arteries (i.e., CAC score ≥100). | Estimated 2–4 times increased probability to suffer a major bleed from aspirin use than to prevent a heart attack with aspirin in participants with no calcified plaque (CAC score = 0) |
| The Aspirin for Asymptomatic Atherosclerosis trial [28] | No significant reduction in fatal or non-fatal coronary event, stroke or revascularization among participants without clinical cardiovascular disease identified with a low ankle brachial index and receiving aspirin in comparison with placebo | |
| Bartolucci et al. [54] | Significant decrease in the risk of total cardiovascular events and nonfatal myocardial infarction | No effect on the reduction in the risk of stroke, cardiovascular mortality, and all-cause mortality |
| Raju et al. [55] | Reduction in all-cause mortality, myocardial infarction (composite of fatal and nonfatal), ischemic stroke, and the composite of myocardial infarction, stroke, and cardiovascular death | Increase in the risk of hemorrhagic stroke, major bleeding, and gastrointestinal bleeding |
| Jones et al. [56] | No differences between aspirin and placebo groups for total and vascular mortality, myocardial infarction, and stroke in patients with asymptomatic peripheral artery disease | |
| Brighton et al. [57] | - Reduction in the occurrence of serious cardiovascular events (by 34 %) other than thromboembolic events | No reduction in recurrent thromboembolic events (with aspirin use of 100 mg/day) |
| - No differences in bleeding or other serious adverse events |