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Aspirin for the Primary Prevention of Cardiovascular Events: An Update of Evidence for the US Preventive Services Task Force: Presented at AAFP

By Laura Gater

CHICAGO, IL -- October 9, 2007 -- There is good evidence that aspirin decreases cardiovascular events in both men and women, explained Kenneth Lin, MD, Agency for Healthcare Research and Quality (AHRQ), Rockville, MD, at the American Academy of Family Physicians (AAFP) Scientific Assembly here on October 5.

A systematic literature search for sex-specific evidence regarding the effect of aspirin on cardiovascular events produced 668 potentially relevant articles for the 2 key questions that Dr. Lin and his colleagues researched. The questions were "Does aspirin use reduce cardiovascular events?" and "Does aspirin harm?"

They included studies that met the following criteria: (1) evaluated aspirin versus control for the prevention of cardiovascular disease events; (2) study population was not comprised of subjects with a history of cardiovascular disease (CVD) or at very high risk of CVD; (3) study population was generalizable to the US primary care population; (4) risk estimates for one of the following outcomes were calculated: for benefits: myocardial infarction (MI), stroke, death from MI or stroke, all-cause death; for harms: gastrointestinal (GI) bleeding, hemorrhagic stroke, cerebral hemorrhage.

The study produced "good evidence," according to Dr. Lin, that aspirin decreases the incidence of CVD in men and women. It decreased coronary events in men and decreased ischemic strokes in women.

Measurements included risk estimates for the following outcomes: for benefits: MI, stroke, death from MI or stroke, all-cause death; for harms: GI bleeding, hemorrhagic stroke, cerebral hemorrhage. Evidence was obtained from 6 fair to good quality, randomized, controlled trials (RCTs), reported Dr. Lin. Men in these trials experienced a reduction in the number of MIs and women experienced a reduction in the number of ischemic strokes.

Aspirin does not appear to affect CVD mortality or all-cause mortality in either men or women. The use of aspirin for primary prevention increases the risk of major bleeding events, primarily GI bleeds in both men and women. Men have an increased risk of hemorrhagic stroke with aspirin use, while a new RCT and meta-analysis suggest that the risk of hemorrhagic stroke in women is not significantly increased.

The percentage reporting any GI symptoms as a result of taking aspirin was virtually identical in both groups, reported Dr. Lin; however, there is good evidence that aspirin increases major bleeding. The literature revealed 2.5 bleeding events per 1,000 women and 3 bleeding events per 1,000 men.


[Presentation title: Aspirin for the Primary Prevention of Cardiovascular Events: An Update of the Evidence for the USPSTF.]

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