Coronary artery diseaseMeta-Analysis of Data from the Six Primary Prevention Trials of Cardiovascular Events Using Aspirin
Section snippets
Methods
The United States Preventive Services Task Force described the data collection and analysis from the first 5 primary prevention trials (BDT, PHS, TPT, HOT, and PPP)3 and, with the addition of the new data from the WHS,4 is the key source of data.
Because aspirin could have a differential effect on different aspects of CV disease, outcomes were classified as follows: (1) total CHD as nonfatal and fatal MI and death due to CHD; (2) nonfatal MI as confirmed MI that did not result in death; (3)
Results
Among the trials in the analysis, there were 47,293 subjects who were treated with aspirin and 45,580 who received placebo/control.
Table 2 lists each study and indicates if statistical significance of aspirin over placebo was reached when using the odds ratio in any of the end points or groups of end points. Overall, these data provide clear evidence of the benefit of aspirin in total CHD, nonfatal MI, and total CV events and a positive trend for all-cause mortality; these effects are
Discussion
Patients without any apparent history of CV disease were enrolled in the 6 large, randomized, primary prevention trials, and systematic analysis of the outcomes from these trials suggests that aspirin decreases the incidence of CHD events, nonfatal MI, and CV events. However, aspirin had no statistically significant effect on stroke, fatal CHD, or all-cause mortality. Whether there is an overall benefit of aspirin therapy in patients at low to moderate CV risk has been discussed elsewhere and is
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This study was supported by an unrestricted research grant from Bayer HealthCare LLC, Morristown, New Jersey.