Aspirin in the Treatment and Prevention of Cardiovascular Disease: Need for Individual Clinical Judgments

Abstract

In secondary prevention—among survivors of a myocardial infarction (MI), occlusive stroke, transient ischemic attack, or CABG surgery or those with stable angina—aspirin significantly reduces the risk of subsequent MI, stroke, and vascular death. Furthermore, in patients suffering an acute MI, occlusive stroke, or unstable angina, aspirin significantly reduces the risks of MI, stroke, and vascular death. In primary prevention, however, the totality of evidence is insufficient upon which to make general guidelines for aspirin. In large-scale trials of primary prevention in men and women without established CVD, and subsequent meta-analyses, aspirin produced a significant reduction in the risk of a first MI, but not that of stroke or cardiovascular death. In addition, in primary prevention the absolute benefit is far lower, because the average 10-year absolute risk of CHD in apparently healthy individuals included in the trials of primary prevention was 10 %. Finally, patients with prior gastrointestinal bleeding, as well as those taking nonsteroidal anti-inflammatory drugs, or with gastrointestinal symptoms due to ulcer disease are all at increased risk of developing major bleeding when taking aspirin.