To reassess the role of aspirin in primary cardiovascular prevention by analyzing recent evidence and addressing discrepancies in previous studies, emphasizing the need for clarity in conflicting results.
Key Findings:
The benefit of aspirin in preventing major adverse cardiovascular events (MACE) increases with higher baseline cardiovascular risk, where MACE refers to death, myocardial infarction, and stroke.
The risk of major bleeding also increases with risk but at a slower rate, leading to a divergence between the two lines as risk increases.
Aspirin may be beneficial for individuals with a calculated cardiovascular risk exceeding 10-20 MACE per 100 patients at 10 years, which should be clearly defined.
Interpretation:
The analysis suggests that aspirin can be considered for primary prevention in individuals at medium to high cardiovascular risk, which should be defined more clearly, despite previous inconclusive findings.
Limitations:
Reliance on aggregated data rather than individual patient data, which may obscure individual variability.
Inability to fully capture the decrease in baseline cardiovascular risk due to improved preventive measures, which may affect the applicability of findings.
Imprecision in risk factor estimates and variability in benefit-risk ratios among older or frail patients, which should be acknowledged.
Conclusion:
Aspirin should be responsibly used in primary prevention for high-risk individuals, with shared decision-making and consideration of lifestyle measures to mitigate bleeding risks, emphasizing the importance of patient education.
