Aspirin for Primary Prevention: A New Meta-Analysis

Studies of aspirin for primary prevention of adverse cardiovascular (CV) events have yielded conflicting results. Among three recently published studies (ASCEND [NEJM JW Gen Med Oct 1 2018 and N Engl J Med 2018; 379:1529]; ARRIVE [NEJM JW Gen Med Oct 1 2018 and Lancet 2018; 392:1036]; and ASPREE [NEJM JW Gen Med Oct 15 2018 and N Engl J Med 2018; 379:1499, 1509, and 1519]), the latter two showed no CV benefit and modest, but statistically significant, excess bleeding risk. This updated meta-analysis includes these three studies plus 10 older ones. Median baseline risk for the primary composite CV outcome of CV-related mortality, nonfatal myocardial infarction, and nonfatal stroke was 9.2%. Most studies involved aspirin doses between 75 mg a…