Aspirin as Primary Prevention of Acute Coronary Heart Disease Events.

Stephen Glasser,Todd Brown,George Howard,Martha Hovater,Monika Safford

doi:10.9734/bjmmr/2014/11212

Abstract

Background/ObjectiveAspirin for primary prophylaxis is controversial. This study evaluated associations between prophylactic aspirin use and incident acute coronary heart disease (CHD) events.Methods and ResultsThe Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study was accessed for aspirin use examining black and white hazards for incident CHD, for men and women, each adjusting incrementally for sampling, sociodemographics, and CHD risk factors. Stratified models examined risks across strata of the Framingham risk score, and all-cause mortality. 23,949 participants (mean 64 yo), had 503 incident events over a 3.5 year follow-up. Prophylactic aspirin use was not associated with incident acute CHD, HR 1.05 (95% CI 0.86, 1.29). Modeling had little impact on the HR (1.09 {95% CI 0.89, 1.33) nor did the addition of risk factors (HR 1.00 {95% CI 0.81, 1.23). Aspirin use was not associated with incident CHD for any Framingham risk level. Findings were similar when including all aspirin users (not just those taking aspirin prophylactically), and when examining associations with all-cause mortality. There was no excess hospitalized bleeding in the aspirin users.ConclusionAspirin was not associated with lower risk for incident acute CHD overall, or within race, gender, or Framingham Risk Score.

Highlights

Aspirin is an effective anti-platelet and anti-inflammatory agent [1]
Aspirin was not associated with lower risk for incident acute coronary heart disease (CHD) overall, or within race, gender, or Framingham Risk Score
A recent task force publication addressed the use of aspirin for the primary prevention of ischemic stroke (3), but the recommendation for the use of aspirin for primary prevention of coronary heart disease (CHD) is less clear; and, the risk/benefit is perhaps an even more important consideration for primary compared to secondary prevention

Summary

Introduction

In a meta-analysis of trials of aspirin in the secondary prevention of cardiovascular and cerebrovascular events, aspirin significantly reduced the number of strokes and myocardial infarctions (MI) [2]. The US Preventive Services Task Force estimates that for baseline risks of 1%, 3%, and 5%, 1–4, 4–12, and 6–20 CHD events can be avoided with aspirin primary prophylaxis, but at the risk of 0–2 hemorrhagic strokes and 2–4 major GI bleeds [3]. As primary prophylaxis, it is not clear at what risk levels the benefits of aspirin use outweigh its risks

Methods

Results

Discussion

Conclusion