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

Inbar Raber, Cian P. McCarthy, Muthiah Vaduganathan, Deepak L. Bhatt, David A. Wood, John G.F. Cleland, Roger S. Blumenthal, John W. McEvoy

Research output: Contribution to journalReview articlepeer-review

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.

Original languageEnglish (US)
Pages (from-to)2155-2167
Number of pages13
JournalThe Lancet
Volume393
Issue number10186
DOIs
StatePublished - May 25 2019

ASJC Scopus subject areas

  • Medicine(all)

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