Aspirin for primary prevention

doi:10.1136/bmj.321.7274.1472

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 riskis >15%, provided that any hypertension is controlled.¹ Thisconclusion comes from conservative interpretation of a meta-analysisexamining the balance of benefit and risk in four large randomisedcontrolled trials of aspirin for primary prevention, and fullysupports recommendations in the Joint British Societies and BritishHypertension Society guidelines.² One assumption central tothis analysis, and to these guidelines, is that relative riskreduction by aspirin is constant, so that the magnitude of benefitfrom aspirin is determined by pretreatment coronaryrisk.

Unfortunately, Meade et al did not examine this assumption in their subgroup analysis of the thrombosis prevention trial.³Rather, they present subgroup analyses according to individualrisk factors (systolic blood pressure, age, and cholesterol concentration).These analyses are not really apposite to the guidelines and mayeven be . . . [Full text of this article]

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Determination of who may derive most benefit from aspirin in primary prevention: subgroup results from a randomised controlled trial: T W Meade and P J Brennan
BMJ 2000 321: 13-17. [Abstract] [Full Text] [PDF]

British Hypertension Society guidelines for hypertension management 1999: summary: Lawrence E Ramsay, Bryan Williams, G Dennis Johnston, Graham A MacGregor, Lucilla Poston, John F Potter, Neil R Poulter, and Gavin Russell
BMJ 1999 319: 630-635. [Extract] [Full Text] [PDF]