Tracy Wolff, MD, MPH; Therese Miller, DrPH; Stephen Ko, MD, MPH
Coronary heart disease and cerebrovascular disease are leading causes of death in the United States. In 2002, the U.S. Preventive Services Task Force (USPSTF) strongly recommended that clinicians discuss aspirin with adults who are at increased risk for coronary heart disease.
To determine the benefits and harms of taking aspirin for the primary prevention of myocardial infarctions, strokes, and death.
MEDLINE and Cochrane Library (search dates, 1 January 2001 to 28 August 2008), recent systematic reviews, reference lists of retrieved articles, and suggestions from experts.
English-language randomized, controlled trials (RCTs); caseâ€“control studies; meta-analyses; and systematic reviews of aspirin versus control for the primary prevention of cardiovascular disease (CVD) were selected to answer the following questions: Does aspirin decrease coronary heart events, strokes, death from coronary heart events or stroke, or all-cause mortality in adults without known CVD? Does aspirin increase gastrointestinal bleeding or hemorrhagic strokes?
All studies were reviewed, abstracted, and rated for quality by using predefined USPSTF criteria.
New evidence from 1 good-quality RCT, 1 good-quality meta-analysis, and 2 fair-quality subanalyses of RCTs demonstrates that aspirin use reduces the number of CVD events in patients without known CVD. Men in these studies experienced fewer myocardial infarctions and women experienced fewer ischemic strokes. Aspirin does not seem to affect CVD mortality or all-cause mortality in either men or women. The use of aspirin for primary prevention increases the risk for major bleeding events, primarily gastrointestinal bleeding events, in both men and women. Men have an increased risk for hemorrhagic strokes with aspirin use. A new RCT and meta-analysis suggest that the risk for hemorrhagic strokes in women is not statistically significantly increased.
New evidence on aspirin for the primary prevention of CVD is limited. The dose of aspirin used in the RCTs varied, which prevented the estimation of the most appropriate dose for primary prevention. Several of the RCTs were conducted within populations of health professionals, which potentially limits generalizability.
Aspirin reduces the risk for myocardial infarction in men and strokes in women. Aspirin use increases the risk for serious bleeding events.
CHD = coronary heart disease; CVD = cardiovascular disease; GI = gastrointestinal; KQ = key question.
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Universidad Nacional AutÃ³noma de MÃ©xico
March 20, 2009
Aspirin for the essential arterial hypertension
TO THE EDITOR:
I read with interest the article by Wolff,et al. (1), about the use of aspirin into patients with coronary heart and cerebrovascular diseases. These authors concluded that the regular use of aspirin reduced the risk for myocardial infarction in men and strokes in women. However another author informs that low-dose aspirin did not reduce the risk of cardiovascular events (2), but in the prevention of ischemic stroke and other vascular events (3,4).
I report the use of aspirin and clonazepam into two patients with essential arterial hypertension(EAH)(unpublished observations ). CASE 1: A 65-year-old man with history of EAH and treated with captopril, however, since July 2000,he received aspirin (500 mg/d) and clonazepam (2 mg/d) as supplementary medication. Four years later, his blood pressure was normalized and without anti-hypertensive therapy. CASE 2: A 62-year-old woman who suffered from stress,sleep disorders and EAH since ten months before her admission. From the first (March 2008), she received only aspirin and clonazepam. At present, one year later, her blood pressure is normal (110/60 to 120/80 mmHg). These clinical observations suggest that the regular use of aspirin may reduce or normalize EAH; due, possibly,to its anti-inflammatory and anti-thrombotic effect in the posterior hypothalamic nuclei (3,5).
1. Wolff T,Miller T,Ko S.Aspirin for the primary prevention of cardiovascular events:An update of the evidence for the U.S.Preventive services task force.Ann Intern Med 2009;150(6):405-410.
2. Ogawa H,Nakayama M,Morimoto T,Uemura S,Kanauchi M,Doi N,et al.Low-dose aspirin for primary prevention of atherosclerotic events in patients with type 2 diabetes.A randomized controlled trial.JAMA 2008;300:2134-2141.
3. Wahner AD,Bronstein JM,Bordelon YM,Ritz B.Nonsteroidal anti-inflammatory drugs may protect against Parkinson disease. Neurology 2007;69:1836-1842.
4. Li Z-G,Yu Z-C,Wang D-Z,Ju W-P,Zhan X,Wu Q-Z,et al. Influence of acetylsalicylate on plasma lysophosphatidic acid level in patients with ischemic cerebral vascular diseases. Neurol Res 2008;30(4):366-369.
5. Rafael H.Neurogenic hypertension. J Neurosurg 2003;99:1117-1118.
Tracy Wolff, Therese Miller, Stephen Ko. Aspirin for the Primary Prevention of Cardiovascular Events: An Update of the Evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2009;150:405–410. doi: 10.7326/0003-4819-150-6-200903170-00009
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Published: Ann Intern Med. 2009;150(6):405-410.
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