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Aspirin for primary prevention

BMJ 2000; 321 doi: (Published 09 December 2000) Cite this as: BMJ 2000;321:1472

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

  1. Lawrence E Ramsay, professor of clinical pharmacology and therapeutics (,
  2. Philemon S Sanmuganathan, lecturer,
  3. Erica J Wallis, research fellow,
  4. Peter R Jackson, reader
  1. Department of Clinical Pharmacology and Therapeutics, Royal Hallamshire Hospital, Sheffield S10 2JF
  2. 211 St Patrick Street, Apt#506C, M5T 2Y9, Toronto, Ontario, Canada

    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 …

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