Aspirin in the Primary Prevention of Myocardial Infarction

Abstract

Featured Article: Steering Committee of the Physicians' Health Study Research Group: Belanger C, Buring JE, Cook N, Eberlein K, Goldhaber SZ, Gordon D, et al. Final report on the aspirin component of the ongoing Physicians' Health Study. N Engl J Med 1989;321:129–35.4 In 1897, Felix Hoffman, a chemist working at Bayer in Elberfeld, Germany, synthesized the first stable form of acetylsalicylic acid. He was motivated, in part, to help his father, who suffered from painful and disabling arthritis. In the 20th century, acetylsalicylic acid, under its trade name, aspirin, became the most widely used drug in the world, but not until 1971 did Sir John Vane elucidate a new and novel mechanism of aspirin to irreversibly inhibit platelet aggregation. In 1982, Vane was awarded the Nobel Prize in physiology or medicine, but the role of aspirin in the prevention of a first myocardial infarction (MI)5 was yet to be discovered. In 1982, the Physicians' Health Study (PHS) was funded by the US NIH as an investigator-initiated research grant. The PHS randomized 22 071 dedicated and conscientious male physicians at low risk of a first cardiovascular disease (CVD) event. On December 18, 1987, the independent Data and Safety Monitoring Board of the PHS unanimously recommended the early termination of the aspirin component, primarily because of the emergence of a statistically …