Aspirin in Primary Prevention of Cardiovascular Disease and Cancer: A Systematic Review of the Balance of Evidence from Reviews of Randomized Trials

“…Consistent with the 2014 FDA guideline 9 and findings from previous randomized trials for primary and secondary prevention, 10-13 we found that daily aspirin use was associated with a reduction in cardiovascular mortality among individuals who reported a history of cardiovascular events, but not among those without a prior history. In 2016, the USPSTF updated their recommendations for aspirin for primary prevention based on an individual's estimated 10-year cardiovascular disease risk.…”

“…The main limitation of this study was that it excluded some other large primary prevention clinical trials, such as the Women's Health Study and Physicians’ Health Study, which studied alternate-day aspirin use and did not show any beneficial effect of aspirin use. 29–31 Thus, in the subsequent meta-analysis study, Sutcliffe et al 31 included the Women's Health Study and Physicians’ Health Study in their updated meta-analysis for clinical trials and suggested that aspirin risks may outweigh benefits in healthy adults for primary prevention, further supporting our findings.…”

“…These findings suggest that aspirin therapy in patients with non-obstructive CAD is beneficial only when they are at higher risk,[ 34 – 36 ] which is concordant with previous studies. [ 37 ] Given the consistent benefit of aspirin on non-fatal MI as shown in previous trials,[ 13 , 27 – 29 ] it might be reasonable to use aspirin in primary prevention for patients with higher cardiovascular risk and with evidence of coronary atherosclerosis. On the other hand, the use of aspirin in patients with non-obstructive CAD is not justifiable among those with lower risk.…”

“…Consistent with the 2014 FDA guideline 9 and findings from previous randomized trials for primary and secondary prevention, 10-13 we found that daily aspirin use was associated with a reduction in cardiovascular mortality among individuals who reported a history of cardiovascular events, but not among those without a prior history. In 2016, the USPSTF updated their recommendations for aspirin for primary prevention based on an individual's estimated 10-year cardiovascular disease risk.…”

“…The main limitation of this study was that it excluded some other large primary prevention clinical trials, such as the Women's Health Study and Physicians’ Health Study, which studied alternate-day aspirin use and did not show any beneficial effect of aspirin use. 29–31 Thus, in the subsequent meta-analysis study, Sutcliffe et al 31 included the Women's Health Study and Physicians’ Health Study in their updated meta-analysis for clinical trials and suggested that aspirin risks may outweigh benefits in healthy adults for primary prevention, further supporting our findings.…”

“…These findings suggest that aspirin therapy in patients with non-obstructive CAD is beneficial only when they are at higher risk,[ 34 – 36 ] which is concordant with previous studies. [ 37 ] Given the consistent benefit of aspirin on non-fatal MI as shown in previous trials,[ 13 , 27 – 29 ] it might be reasonable to use aspirin in primary prevention for patients with higher cardiovascular risk and with evidence of coronary atherosclerosis. On the other hand, the use of aspirin in patients with non-obstructive CAD is not justifiable among those with lower risk.…”

“…Consistent with the 2014 FDA guideline 9 and findings from previous randomized trials for primary and secondary prevention, 10-13 we found that daily aspirin use was associated with a reduction in cardiovascular mortality among individuals who reported a history of cardiovascular events, but not among those without a prior history. In 2016, the USPSTF updated their recommendations for aspirin for primary prevention based on an individual's estimated 10-year cardiovascular disease risk.…”

“…The main limitation of this study was that it excluded some other large primary prevention clinical trials, such as the Women's Health Study and Physicians’ Health Study, which studied alternate-day aspirin use and did not show any beneficial effect of aspirin use. 29–31 Thus, in the subsequent meta-analysis study, Sutcliffe et al 31 included the Women's Health Study and Physicians’ Health Study in their updated meta-analysis for clinical trials and suggested that aspirin risks may outweigh benefits in healthy adults for primary prevention, further supporting our findings.…”

“…These findings suggest that aspirin therapy in patients with non-obstructive CAD is beneficial only when they are at higher risk,[ 34 – 36 ] which is concordant with previous studies. [ 37 ] Given the consistent benefit of aspirin on non-fatal MI as shown in previous trials,[ 13 , 27 – 29 ] it might be reasonable to use aspirin in primary prevention for patients with higher cardiovascular risk and with evidence of coronary atherosclerosis. On the other hand, the use of aspirin in patients with non-obstructive CAD is not justifiable among those with lower risk.…”