A Randomized Trial of Low-Dose Aspirin in the Primary Prevention of Cardiovascular Disease in Women

Ridker, Paul M.; Cook, Nancy R.; Lee, I-Min; Gordon, David; Gaziano, J. Michael; Manson, JoAnn E.; Hennekens, Charles H.; Buring, Julie E.

doi:10.1056/nejmoa050613

Cited by 1,755 publications

(1,295 citation statements)

References 23 publications

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“…For primary prevention, large randomized clinical trials were first published in 1989, with the Physician's Health Study showing benefit of low‐dose aspirin in preventing AMI among healthy middle‐aged men 4. A comparable benefit of aspirin to prevent first ischemic stroke was demonstrated in the Women's Health Study 5. In a meta‐analysis, investigators observed a significant 12% relative risk reduction in nonfatal cardiovascular events achieved with aspirin use among previously healthy adults 3.…”

Section: Discussionmentioning

confidence: 99%

“…Aspirin is widely accepted for secondary prevention after a myocardial infarction or stroke 3. After review of data from multiple prospective randomized clinical trials,4, 5, 6 the United States Preventive Services Task Force (USPSTF) in 2009 published a strong 1A recommendation in favor of use of low‐dose aspirin for primary prevention in men aged 45 to 79 years and women aged 55 to 79 years in whom benefit would be anticipated to exceed risk 7. The recommendation in favor of aspirin use was also included in an American Heart Association prevention guidelines,8, 9, 10, 11 the recent Healthy People 2020 plan,12 and the “Million Hearts Initiative” of the Centers for Medicare and Medicaid Services and Centers for Disease Control and Prevention 13…”

Section: Introductionmentioning

confidence: 99%

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Population Trends in Aspirin Use for Cardiovascular Disease Prevention 1980–2009: The Minnesota Heart Survey

Luepker

Steffen

Duval

et al. 2015

JAHA

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BackgroundDaily low‐dose aspirin is recommended for primary prevention of myocardial infarction and stroke in higher‐risk patients. Population trends in aspirin use for cardiovascular disease (CVD) prevention in an urban population (Minneapolis/St. Paul, 2010 population 2.85 million) from 1980 to 2009 were evaluated.Methods and ResultsSurveys of randomly selected adults aged 25 to 74 years were collected at 5‐year intervals. Self‐reports of regular aspirin use for CVD prevention and history of CVD were obtained. Six cross‐sectional surveys included 12 281 men and 14 258 women. Age‐adjusted aspirin use for primary prevention increased during this period from 1% to 21% among men and 1% to 12% among women. Aspirin use was highest in those aged 65 to 74 years. For secondary prevention, age‐adjusted aspirin use increased from 19% to 74% among men and 11% to 64% among women. While data are based on self‐report, a substudy using a biochemical indicator of aspirin use (serum thromboxane B2) supports the validity of self‐report.ConclusionsAspirin for CVD prevention is commonly used by a large and growing portion of the general population. It is not known if this is based on professional advice or self‐prescribed use. It is also likely that many who would benefit do not use aspirin and others use aspirin inappropriately.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Population Trends in Aspirin Use for Cardiovascular Disease Prevention 1980–2009: The Minnesota Heart Survey

Luepker

Steffen

Duval

et al. 2015

JAHA

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“…Reductions in CVD morbidity and mortality have been achieved by reducing risk factor exposure with lifestyle and pharmacologic interventions, including use of aspirin 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15. Aspirin has been demonstrated to prevent a first myocardial infarction (MI) or stroke among individuals at high risk12, 13 and to be cost‐effective 16, 17. It also decreases the risk of subsequent cardiovascular events and death among individuals who have already experienced an MI or stroke 14, 15…”

Section: Introductionmentioning

confidence: 99%

Contemporary Primary Prevention Aspirin Use by Cardiovascular Disease Risk: Impact of US Preventive Services Task Force Recommendations, 2007—2015: A Serial, Cross‐sectional Study

Hof

Duval

Walts

et al. 2017

JAHA

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BackgroundNo previous study has evaluated the impact of past US Preventive Services Task Force statements on primary prevention (PP) aspirin use in a primary care setting. The aim of this study was to evaluate temporal changes in PP aspirin use in a primary care population, stratifying patients by their 10‐year global cardiovascular disease risk, in response to the 2009 statement.Methods and ResultsThis study estimated biannual aspirin use prevalence using electronic health record data from primary care clinics within the Fairview Health System (Minnesota) from 2007 to 2015. A total of 94 270 patient encounters had complete data to estimate a 10‐year cardiovascular disease risk score using the 2013 American College of Cardiology/American Heart Association global risk estimator. Patients were stratified into low‐ (<10%), intermediate‐ (10–20%), and high‐ (≥20%) risk groups. Over the 9‐year period, PP aspirin use averaged 43%. When stratified by low, intermediate and high risk, average PP aspirin use was 41%, 63%, and 73%, respectively. Average PP aspirin use decreased after the publication of the 2009 US Preventive Services Task Force recommendation statement: from 45% to 40% in the low‐risk group; from 66% to 62% in the intermediate‐risk group; and from 76% to 73% in the high‐risk group, before and after the guideline.ConclusionsPublication of the 2009 US Preventive Services Task Force recommendation was not associated with an increase in aspirin use. High risk PP patients utilized aspirin at high rates. Patients at intermediate risk were less intensively treated, and patients at low risk used aspirin at relatively high rates. These data may inform future aspirin guideline dissemination.

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“…Clinical trials conducted in Western countries have reported conflicting results regarding the benefit of aspirin for primary stroke prevention 2, 3, 4. According to a meta‐analysis reported by the Antithrombotic Trialists’ Collaboration (ATT), aspirin did not reduce the risk of stroke for primary prevention 1 (Table 3).…”

Section: Discussionmentioning

confidence: 99%

“…Aspirin has been proven to have a larger benefit than risk in secondary stroke prevention,1 although clinical trials of aspirin conducted in Western countries have reported conflicting results regarding the efficacy for primary stroke prevention,2, 3, 4 and there is no evidence available for Asian population, which might have a different risk‐benefit profile from that in Western population. However, hemorrhagic stroke is more likely to occur in Asian population than in Western population 5, 6.…”

Section: Introductionmentioning

confidence: 99%

Aspirin for primary stroke prevention in elderly patients with vascular risk factors

Uchiyama

2017

J of Gen and Family Med

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The effect of aspirin in primary stroke prevention is controversial in Western population, and no evidence is available in Asian population. We performed stroke subanalysis of the Japanese Primary Prevention Project (JPPP), which was a randomized controlled trial of aspirin vs no aspirin for primary prevention of vascular events in 14 464 patients aged over 60 years with hypertension, diabetes, and/or dyslipidemia. We evaluated the effects of aspirin on the risk of stroke and intracranial hemorrhage. Aspirin did not show any net benefit for primary stroke prevention during median follow‐up for 5 years, because nonsignificant reduction in ischemic stroke was offset by nonsignificant increase in hemorrhagic stroke. Aspirin is not recommended for primary stroke prevention in elderly Japanese patients with vascular risk factors in general. Asymptomatic large artery atherosclerosis appears to be a new target for primary prevention of stroke.

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A Randomized Trial of Low-Dose Aspirin in the Primary Prevention of Cardiovascular Disease in Women

Abstract: In this large, primary-prevention trial among women, aspirin lowered the risk of stroke without affecting the risk of myocardial infarction or death from cardiovascular causes, leading to a nonsignificant finding with respect to the primary end point.

Cited by 1,755 publications

References 23 publications

Population Trends in Aspirin Use for Cardiovascular Disease Prevention 1980–2009: The Minnesota Heart Survey

Population Trends in Aspirin Use for Cardiovascular Disease Prevention 1980–2009: The Minnesota Heart Survey

Contemporary Primary Prevention Aspirin Use by Cardiovascular Disease Risk: Impact of US Preventive Services Task Force Recommendations, 2007—2015: A Serial, Cross‐sectional Study

Aspirin for primary stroke prevention in elderly patients with vascular risk factors

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