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Lancet. 2019 May 25;393(10186):2155-2167. doi: 10.1016/S0140-6736(19)30541-0.

The rise and fall of aspirin in the primary prevention of cardiovascular disease.

Author information

1
Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
2
Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
3
Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA, USA.
4
National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland; National Heart and Lung Institute, Imperial College, London, UK.
5
National Heart and Lung Institute, Imperial College, London, UK; Robertson Centre for Biostatistics and Clinical Trials, University of Glasgow, Glasgow, UK.
6
Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
7
National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland; Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Division of Cardiology, Department of Medicine, Saolta University Healthcare Group, University College Hospital Galway, Galway, Ireland. Electronic address: johnwilliam.mcevoy@nuigalway.ie.

Abstract

Aspirin is one of the most frequently used drugs worldwide and is generally considered effective for the secondary prevention of cardiovascular disease. By contrast, the role of aspirin in primary prevention of cardiovascular disease is controversial. Early trials evaluating aspirin for primary prevention, done before the turn of the millennium, suggested reductions in myocardial infarction and stroke (although not mortality), and an increased risk of bleeding. In an effort to balance the risks and benefits of aspirin, international guidelines on primary prevention of cardiovascular disease have typically recommended aspirin only when a substantial 10-year risk of cardiovascular events exists. However, in 2018, three large randomised clinical trials of aspirin for the primary prevention of cardiovascular disease showed little or no benefit and have even suggested net harm. In this narrative Review, we reappraise the role of aspirin in primary prevention of cardiovascular disease, contextualising data from historical and contemporary trials.

PMID:
31226053
DOI:
10.1016/S0140-6736(19)30541-0
[Indexed for MEDLINE]

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