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

Raber, I., McCarthy, C. P., Vaduganathan, M., Bhatt, D. L., Wood, D. A., Cleland, J. G.F. , Blumenthal, R. S. and McEvoy, J. W. (2019) The rise and fall of aspirin in the primary prevention of cardiovascular disease. Lancet, 393(10186), pp. 2155-2167. (doi: 10.1016/S0140-6736(19)30541-0)

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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.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Cleland, Professor John
Authors: Raber, I., McCarthy, C. P., Vaduganathan, M., Bhatt, D. L., Wood, D. A., Cleland, J. G.F., Blumenthal, R. S., and McEvoy, J. W.
Subjects:R Medicine > R Medicine (General)
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
Journal Name:Lancet
Publisher:The Lancet Publishing Group
ISSN:0140-6736
ISSN (Online):1474-547X
Published Online:23 May 2019
Copyright Holders:Copyright © 2019 Elsevier
First Published:First published in Lancet 393(10186):2155-2167
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher

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