TY - JOUR
T1 - The rise and fall of aspirin in the primary prevention of cardiovascular disease
AU - Raber, Inbar
AU - McCarthy, Cian P.
AU - Vaduganathan, Muthiah
AU - Bhatt, Deepak L.
AU - Wood, David A.
AU - Cleland, John G.F.
AU - Blumenthal, Roger S.
AU - McEvoy, John W.
N1 - Funding Information:
MV is supported by the KL2/Catalyst Medical Research Investigator Training award from Harvard Catalyst (National Institutes of Health award UL 1TR002541), and serves on advisory boards to AstraZeneca, Bayer, and Baxter Healthcare. DLB is on the advisory boards of Cardax, Elsevier PracticeUpdate Cardiology, Medscape Cardiology, and Regado Biosciences; the board of directors at the Boston Research Institute and the Society of Cardiovascular Patient Care, TOBESOFT; is Chair of the American Heart Association Quality Oversight Committee; is on data monitoring committees at Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute; for the PORTICO trial [ NCT02000115 ], funded by St Jude Medical [now Abbott]), Cleveland Clinic (including for the ExCEED trial [ NCT03517436 ], funded by Edwards Lifesciences), Duke Clinical Research Institute, Mayo Clinic, Icahn School of Medicine at Mount Sinai (for the ENVISAGE trial [ NCT02943785 ], funded by Daiichi Sankyo), the Population Health Research Institute; receives honoraria from the American College of Cardiology (Senior Associate Editor, Clinical Trials and News, ACC.org; Vice-Chair, Accreditation Committee), Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute; RE-DUAL PCI clinical trial [ NCT02164864 ] steering committee funded by Boehringer Ingelheim), Belvoir Publications (Editor-in-Chief, Harvard Heart Letter), Duke Clinical Research Institute (clinical trial steering committees), Health Management Publications Global (Editor-in-Chief, Journal of Invasive Cardiology), Journal of the American College of Cardiology (Guest Editor; Associate Editor), Population Health Research Institute (for the COMPASS trial [ NCT01776424 ] operations committee, publications committee, and steering committee, and as US national co-leader; funded by Bayer), SLACK (Chief Medical Editor, Cardiology Today's Intervention), Society of Cardiovascular Patient Care (Secretary and Treasurer), WebMD (Continuing Medical Education steering committees); does unpaid activities for Clinical Cardiology (Deputy Editor), National Cardiovascular Data Registry (Chest Pain, Myocardial Infarction Registry) Steering Committee (Chair), and Veterans Affairs Clinical Assessment Reporting and Tracking Research and Publications Committee (Chair); receives research funding from Abbott, Amarin, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Chiesi, Eisai, Ethicon, Forest Laboratories, Idorsia, Ironwood, Ischemix, Lilly, Medtronic, PhaseBio, Pfizer, Regeneron, Roche, Sanofi, Synaptic, and The Medicines Company; receives royalties from Elsevier (Editor, Cardiovascular Intervention: A Companion to Braunwald's Heart Disease); is a site co-investigator for Biotronik, Boston Scientific, St Jude Medical (now Abbott), Svelte Medical Systems; is a trustee for the American College of Cardiology; and has done unfunded research for FlowCo, Merck, Novo Nordisk, PLx Pharma, and Takeda. JGFC reports grants and personal fees from Amgen, Bayer, Bristol-Myers Squibb, Philips, Stealth BioTherapeutics, and Torrent Pharmaceuticals; personal fees from AstraZeneca, GlaxoSmithKline, MyoKardia, Sanofi, and Servier; grants, personal fees, and non-financial support from Medtronic, Novartis, and Vifor Pharma; and grants and non-financial support from Pharmacosmos and PharmaNord. DAW received grant support from the European Society of Cardiology. All other authors have no competing interests.
Publisher Copyright:
© 2019 Elsevier Ltd
PY - 2019/5/25
Y1 - 2019/5/25
N2 - Aspirin is one of the most frequently used drugs worldwide and is generally considered effective for the secondary prevention of cardiovascular disease. By contrast, the role of aspirin in primary prevention of cardiovascular disease is controversial. Early trials evaluating aspirin for primary prevention, done before the turn of the millennium, suggested reductions in myocardial infarction and stroke (although not mortality), and an increased risk of bleeding. In an effort to balance the risks and benefits of aspirin, international guidelines on primary prevention of cardiovascular disease have typically recommended aspirin only when a substantial 10-year risk of cardiovascular events exists. However, in 2018, three large randomised clinical trials of aspirin for the primary prevention of cardiovascular disease showed little or no benefit and have even suggested net harm. In this narrative Review, we reappraise the role of aspirin in primary prevention of cardiovascular disease, contextualising data from historical and contemporary trials.
AB - Aspirin is one of the most frequently used drugs worldwide and is generally considered effective for the secondary prevention of cardiovascular disease. By contrast, the role of aspirin in primary prevention of cardiovascular disease is controversial. Early trials evaluating aspirin for primary prevention, done before the turn of the millennium, suggested reductions in myocardial infarction and stroke (although not mortality), and an increased risk of bleeding. In an effort to balance the risks and benefits of aspirin, international guidelines on primary prevention of cardiovascular disease have typically recommended aspirin only when a substantial 10-year risk of cardiovascular events exists. However, in 2018, three large randomised clinical trials of aspirin for the primary prevention of cardiovascular disease showed little or no benefit and have even suggested net harm. In this narrative Review, we reappraise the role of aspirin in primary prevention of cardiovascular disease, contextualising data from historical and contemporary trials.
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U2 - 10.1016/S0140-6736(19)30541-0
DO - 10.1016/S0140-6736(19)30541-0
M3 - Review article
C2 - 31226053
AN - SCOPUS:85065983838
SN - 0140-6736
VL - 393
SP - 2155
EP - 2167
JO - The Lancet
JF - The Lancet
IS - 10186
ER -