BMJ 2000;321:1472 ( 9 December )

Letters

Aspirin for primary prevention

    Treatment policy should be based on all trial evidence, not subgroup analysis
    Doctors and patients should understand potential benefits and risks of aspirin treatment

Treatment policy should be based on all trial evidence, not subgroup analysis

The first 150 words of the full text of this article appear below.

EDITOR---We have suggested that aspirin for primary prevention is safe and worthwhile when the estimated 10 year coronary risk is >15%, provided that any hypertension is controlled.1 This conclusion comes from conservative interpretation of a meta-analysis examining the balance of benefit and risk in four large randomised controlled trials of aspirin for primary prevention, and fully supports recommendations in the Joint British Societies and British Hypertension Society guidelines.2 One assumption central to this analysis, and to these guidelines, is that relative risk reduction by aspirin is constant, so that the magnitude of benefit from aspirin is determined by pretreatment coronary risk.

Unfortunately, Meade et al did not examine this assumption in their subgroup analysis of the thrombosis prevention trial.3 Rather, they present subgroup analyses according to individual risk factors (systolic blood pressure, age, and cholesterol concentration). These analyses are not really apposite to the guidelines and may even be . . . [Full text of this article]
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This article has been cited by other articles:

  • Meade, T W, Brennan, P J (2001). Authors' reply on aspirin for primary prevention. BMJ 322: 171-171 [Full text]  
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