Aspirin Efficacy in Primary Prevention: A Meta-analysis of Randomized Controlled Trials

Mahmoud Barbarawi; Babikir Kheiri; Yazan Zayed; Inderdeep Gakhal; Ahmad Al-Abdouh; Owais Barbarawi; Laith Rashdan; Fatima Rizk; Ghassan Bachuwa; Mohammad Luay Alkotob

doi:10.1007/s40292-019-00325-5

Aspirin Efficacy in Primary Prevention: A Meta-analysis of Randomized Controlled Trials

High Blood Press Cardiovasc Prev. 2019 Aug;26(4):283-291. doi: 10.1007/s40292-019-00325-5. Epub 2019 Jul 6.

Authors

Affiliations

¹ Department of Internal Medicine, Hurley Medical Center/Michigan State University, One Hurley Plaza, Flint, Michigan, 48503, USA. Mahmoud.albarbarawi@gmail.com.
² Department of Internal Medicine, Hurley Medical Center/Michigan State University, One Hurley Plaza, Flint, Michigan, 48503, USA.
³ Department of Internal Medicine, Saint Agnes Hospital, Baltimore, MD, USA.
⁴ Department of Internal medicine, Mutah University, Al-Karak, Jordan.
⁵ College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA.
⁶ Division of Cardiology, Hurley Medical Center/Michigan State University, Flint, MI, USA.

PMID: 31280451
DOI: 10.1007/s40292-019-00325-5

Abstract

Introduction: The role of aspirin as a means of primary prevention remains controversial.

Aim: We have conducted a meta-analysis of all randomized controlled trials (RCTs) to evaluate the role of aspirin in primary prevention.

Methods: Literature search was performed via PubMed, Embase, and the Cochrane Library for all related RCTs. All-cause mortality was the primary endpoint. Secondary endpoints included major adverse cardiovascular events (MACE), myocardial infarction (MI), cardiovascular mortality, cerebrovascular events, and bleeding events. We used a random effects model to report the risk ratios (RRs) with 95% confidence intervals (CIs).

Results: Our analysis included 17 RCTs (164,862 patients; 83,309 received aspirin and 81,744 received placebo). Our study did not demonstrate any significant reduction in all-cause mortality for patients treated with aspirin when compared with placebo (RR 0.97; 95% CI 0.93-1.01; P = 0.13). Sensitivity analysis performed by excluding healthy elderly (≥ 65) showed significant reductions in all-cause mortality in the aspirin-treated patients (RR 0.94; 95% CI 0.90-0.99; P = 0.01). There were no significant differences between both groups regarding cardiovascular mortality and cerebrovascular events (P > 0.05). However, aspirin-treated patients significantly reduced MACE and MI events (RR 0.89; 95% CI 0.85-0.93; P < 0.001 and RR 0.88; 95% CI 0.78-0.98; P = 0.02, respectively), respectively. However, aspirin was associated with a significantly higher incidence of bleeding, including major bleeding and intracranial bleeding (P < 0.001).

Conclusions: Aspirin use in primary prevention has resulted in a lower incidence of MACE and MI without significantly effecting cerebrovascular events. However, aspirin was associated with a higher bleeding risk. Use of aspirin as a means of primary prevention should be thoroughly discussed with patients and pursued based on the risk of cardiovascular disease while also considering bleeding risk.

Keywords: Aspirin; Cardiovascular disease; Meta-analysis; Primary prevention.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Aspirin / adverse effects
Aspirin / therapeutic use*
Cardiovascular Agents / adverse effects
Cardiovascular Agents / therapeutic use*
Cardiovascular Diseases / diagnosis
Cardiovascular Diseases / mortality*
Cardiovascular Diseases / prevention & control*
Clinical Decision-Making
Hemorrhage / chemically induced
Humans
Incidence
Primary Prevention / methods*
Protective Factors
Randomized Controlled Trials as Topic
Risk Assessment
Risk Factors
Treatment Outcome

Substances

Cardiovascular Agents
Aspirin