This news today from uptodate.com
In secondary prevention of cardiovascular disease (CVD), the absolute benefits of aspirin on occlusive events are greater than the absolute harm of major bleeding. However, for primary prevention, three recent large randomized trials evaluating all-cause mortality associated with aspirin use indicate that the benefits and harms of aspirin for primary prevention are very closely balanced [1-5]. In both the ASCEND trial in patients with diabetes as well as the ARRIVE trial in patients with moderate CVD risk, the risk of all-cause death was similar with or without aspirin [1,5]. In the ASPREE trial of individuals 70 years or older, the risk of death was higher with aspirin (13 versus 11 percent) [2-4]. While we had previously suggested aspirin for primary prevention for most patients over age 40, based on these recent trials indicating that the benefits and harms are so closely balanced, we have chosen not to make a recommendation for or against aspirin use. The decision whether to use aspirin for primary prevention should be made only after a detailed discussion between the patient and health care provider, guided by personal patient preferences and estimated benefits and harms relative to the specific patient. The balance between benefits and harms may weigh more heavily for harms over benefits in those over 70 years of age.
1. ASCEND Study Collaborative Group, Bowman L, Mafham M, et al. Effects of Aspirin for Primary Prevention in Persons with Diabetes Mellitus. N Engl J Med 2018; 379:1529.
2. McNeil JJ, Woods RL, Nelson MR, et al. Effect of Aspirin on Disability-free Survival in the Healthy Elderly. N Engl J Med 2018; 379:1499.
3. McNeil JJ, Wolfe R, Woods RL, et al. Effect of Aspirin on Cardiovascular Events and Bleeding in the Healthy Elderly. N Engl J Med 2018; 379:1509.
4. McNeil JJ, Nelson MR, Woods RL, et al. Effect of Aspirin on All-Cause Mortality in the Healthy Elderly. N Engl J Med 2018; 379:1519.
5. Gaziano JM, Brotons C, Coppolecchia R, et al. Use of aspirin to reduce risk of initial vascular events in patients at moderate risk of cardiovascular disease (ARRIVE): a randomised, double-blind, placebo-controlled trial. Lancet 2018; 392:1036
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