Aspirin for Primary Prevention
There is little controversy surrounding the use of aspirin for the prevention of cardiovascular events in patients with established arteriosclerotic disease(secondary prevention).
There has been a controversy and a confusion with regard to the use of aspirin for primary prevention. A recent large meta-analysis (Arch. Intern. Med. Feb 13, 2012) which analized more than 100,000 patients for the primary prevention showed a modest reduction (10%) of non-fatal myocardial infarction and total CVD events, but no benefits with regard to fatal MI, stroke or CVD death or cancer mortality. This modest benefit was offset by an elevated risk of nontrivial bleed(30% increase). The number needed to treat with aspirin to prevent one nonfatal MI was 162, compared to the number needed to harm for nontrivial bleed of 73.
The authors conclude by saying that "Because the modest benefits of aspirin treatment for primary prevention were accompanied by a significant increase in risk of bleeding, further study is needed to identify subsets of patients with higher-risk for CVD events. In the absence of such information, a reappraisal of current guidelines appears to be warranted."
In patients for low risk, aspirin may certainly do more harm. For those in the middle, a clinical judgement is certainly required in each individual patient. Perhaps creative aspirin dosing, such as every-other-day, could be explored.
ㅡ from AMA News, February 13, 201
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Source of the above information: American Medical News(AMA official news magazine),
February 13, 2012.
Facts: Eight in ten Americans who use internet look for health information online, according to
2010 data from the Pew Internet and American Life Project released in Feb. 2011.