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BMJ 2010; 340 doi: (Published 09 March 2010) Cite this as: BMJ 2010;340:c1347

More evidence against aspirin for primary prevention

In 1998, researchers in Scotland began a large trial of low dose aspirin for adults without clinical cardiovascular disease. The results, now published, suggest that 100 mg of enteric coated aspirin a day is no more effective than placebo at preventing serious vascular events including heart attacks, strokes, and revascularisation procedures (hazard ratio 1.03, 95% CI 0.84 to 1.27). These adults had an ankle brachial index below 0.95, indicating a higher risk of cardiovascular disease than the general population of Scotland. Even so, aspirin did not save lives (hazard ratio for all cause mortality 0.95, 0.77 to 1.16) during more than eight years of follow-up, or protect participants from symptomatic disease (hazard ratio for cardiovascular events, angina, claudication, or transient ischaemic attack 1.00, 0.85 to 1.17). Aspirin caused significantly more major bleeds than placebo (1.71, 0.99 to 2.97), some of which were fatal.

The weight of evidence is now balanced against low dose aspirin for primary prevention, says an editorial (p 880). This trial had its flaws, as most trials do, but if aspirin has any prophylactic effect in this population, it is likely to be small. The harms are more obvious. These researchers screened nearly 30 000 adults aged 50-75 to find the 4914 with a reduced ankle brachial index. They managed to randomise 3350. Around 70% of participants were women.

The ups and downs of ECG screening for athletes

College athletes in the US must pass preparticipation screening by history and examination in an attempt to rule out undiagnosed heart disease. Some experts believe electrocardiography (ECG) should be mandatory too, and in one recent study adding ECG to history and examination improved the sensitivity of screening from 45.5% (95% CI 16.8% to 76.2%) to 90.9% (58.7% to 99.8%). Researchers compared the two strategies with a reference standard—transthoracic echocardiography—in 510 college athletes. Eleven participants had potentially significant …

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