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Don’t use aspirin for primary prevention of cardiovascular disease

BMJ 2010; 340 doi: http://dx.doi.org/10.1136/bmj.c1805 (Published 21 April 2010) Cite this as: BMJ 2010;340:c1805
  1. Helen Barnett, associate editor1,
  2. Peter Burrill, specialist pharmaceutical adviser for public health2,
  3. Ike Iheanacho, editor1
  1. 1Drug and Therapeutics Bulletin, BMJ Group, London WC1H 9JR
  2. 2Derbyshire County Primary Care Trust, NHS Derbyshire County, Chesterfield S41 7PF
  1. Correspondence to: H Barnett hbarnett{at}bmjgroup.com
  • Accepted 15 March 2010

All patients currently taking aspirin for primary prevention should be reviewed individually to reconsider whether such treatment is justified

The clinical problem

Cardiovascular disease accounted for around two million deaths in the European Union in 2000.1 Daily low dose aspirin is established in the secondary prevention of cardiovascular disease.1 2 3 4 In primary prevention, however, use of low dose aspirin is unlicensed in the United Kingdom, and published evidence does not support the assumption that the benefits clearly outweigh the harms. So the routine practice of starting patients on such treatment for primary prevention of cardiovascular disease should be abandoned.

The evidence for change

Whether the benefits of aspirin in people with no history of cardiovascular disease outweigh the risks has been doubted.2 5This is partly because long term, low dose aspirin therapy substantially increases the likelihood of gastrointestinal haemorrhage.6 Also, published evidence has never unequivocally supported the use of aspirin in this setting, and accumulating data have further undermined such practice.

A meta-analysis of six randomised controlled trials (involving a total of 95 000 participants) investigated aspirin for the primary prevention of cardiovascular disease.5 Aspirin use reduced serious vascular events by about 0.07% per year (0.51% per year with aspirin v 0.57% per year with control treatment, P=0.0001). This was due mainly to an absolute reduction of about 0.05% in the likelihood of non-fatal myocardial infarction (0.18% per year v 0.23% per year with control treatment, …

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