Aspirin is widely used for the prevention of cardiovascular events. Although the evidence supporting the use of aspirin for secondary prevention is strong, its role in primary prevention in less clear. Nonetheless, recommendations from the US Preventive Services Task Force (USPSTF) continue to support the use of aspirin for primary cardiovascular prevention in select patients. This article will review current recommendations for primary prevention with aspirin, recent studies that have generated considerable controversy, and implications for clinical practice.
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References
1.
US Preventive Services Task Force. Aspirin for the primary prevention of cardiovascular events: recommendation and rationale. Ann Intern Med.2002; 136(2): 157–160.
2.
RoderickP.J., WilkesH.C., MeadeT.W.The gastrointestinal toxicity of aspirin: an overview of randomised controlled trials. Br J Clin Pharmacol.1993; 35(3): 219–226.
3.
Steering Committee of the Physicians' Health Study Research Group. Final report on the aspirin component of the ongoing Physicians' Health Study. N Engl J Med.1989; 321(3): 129–135.
4.
PetoR., GrayR., CollinsR.. Randomised trial of prophylactic daily aspirin in British male doctors. Br Med J (Clin Res Ed).1988; 296(6618): 313–316.
5.
WolffT., MillerT., KoS.Aspirin for the primary prevention of cardiovascular events: an update of the evidence for the US Prevention Services Task Force. Ann Intern Med.2009; 150(6): 405–410.
6.
RidkerP.M., CookN.R., LeeI.M.. A randomized trial of low-dose aspirin in the primary prevention of cardiovascular disease in women. N Engl J Med.2005; 352(13): 1293–1304.
7.
BergerJ.S., RoncaglioniM.C., AvanziniF.. Aspirin for the primary prevention of cardiovascular events in women and men: a sex-specific meta-analysis of randomized controlled trials. JAMA.2006; 295(3): 306–313.
8.
BaigentC., BlackwellL., CollinsR.; Antithrombotic Trialists' (ATT) Collaboration. Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet.2009; 373(9678): 1849–1860.
9.
CalongeN., LeFevreM.; US Preventative Services Task Force (USPSTF). USPSTF response to the ATT collaboration meta-analysis. Agency for Healthcare Research and Quality Web site. http://www.ahrq.gov/clinic/tfcomments/tfaspattcom.htm. Published 2009. Accessed February 18, 2010.
10.
HanssonL., ZanchettiA., CarruthersS.G..; HOT Study Group. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. Lancet.1998; 351(9118): 1755–1762.
11.
OgawaH., NakayamaM., MorimotoT..; Japanese Primary Prevention of Atherosclerosis With Aspirin for Diabetes (JPAD) Trial Investigators. Low-dose aspirin for primary prevention of atherosclerotic events in patients with type 2 diabetes: a randomized control trial. JAMA.2008; 300(18): 2134–2141.
12.
BelchJ., MacCuishA., CampbellI..; Prevention of Progression of Arterial Disease and Diabetes Study Group; Diabetes Registry Group; Royal College of Physicians Edinburgh. The prevention of progression of arterial disease and diabetes (POPADAD) trial: factorial randomised placebo controlled trial of aspirin and antioxidants in patients with diabetes and asymptomatic peripheral arterial disease. BMJ.2008; 337: a1840.
13.
De BerardisG., SaccoM., StrippoliG.F.. Aspirin for primary prevention of cardiovascular events in people with diabetes: meta-analysis of randomised controlled trials. BMJ.2009; 339: b4531.
14.
American Diabetes Association. Standards for medical care in diabetes—2010. Diabetes Care.2010; 33(suppl 1): S11–S61.
15.
BergerJ., KrantzM.J., KittelsonJ., HiattW.R.Aspirin for the prevention of cardiovascular events in patients with peripheral artery disease: a meta-analysis of randomized trials. JAMA.2009; 301(18): 1909–1919.
16.
ClelandJ.G.F., ColettaA.P., YassinA.. Clinical trials update from the European Society of Cardiology Meeting 2009: AAA, RELY, PROTECT, ACTIVE-1, European CRT survey, German pre-SCD II registry, and MADIT-CRT. Eur J Heart Fail.2009; 11(12): 1214–1219.
