Clinical research studyEffect of Aspirin on Mortality in the Primary Prevention of Cardiovascular Disease
Section snippets
Materials and Methods
We adopted the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines for the reporting of this meta-analysis.20, 21 A protocol was prospectively developed detailing the study objectives, primary and secondary outcomes, criteria for study selection, approach to assessing study quality, data synthesis, and statistical analyses.
Study Selection
The process of study selection is outlined in Figure 1. Reviewer agreement at the level of study selection from full text articles as assessed by Cohen's unweighted kappa was 0.86 (standard error 0.14).
Study Characteristics
Nine studies involving 100,076 participants were included. Study and participant characteristics are summarized in Table 1. Three of the nine studies, the British Doctors Trial (BDT),23 Physicians' Health Study (PHS),24 and Thrombosis Prevention Trial (TPT),25 did not include women, whereas the
Discussion
Our meta-analysis of 9 aspirin primary prevention trials involving 100,076 patients demonstrates that long-term aspirin compared with placebo or no aspirin reduces all-cause mortality, myocardial infarction, and ischemic stroke; does not reduce cardiovascular mortality; and increases hemorrhagic stroke, major bleeding, and gastrointestinal bleeding.
In the absence of a mortality benefit of aspirin, treatment guidelines for the use of aspirin for primary prevention of cardiovascular disease have
Conclusions
Our results demonstrate a consistent pattern of reduced mortality in all of the aspirin primary prevention trials and a significant, albeit modest, reduction in all-cause mortality when the data are pooled. This reduction in all-cause mortality tilts the balance between the benefits and risks of treatment in favor of the use of aspirin. The results of our meta-analysis are in agreement with those of the 2009 Antithrombotic Trialists' Collaboration meta-analysis in secondary prevention and
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Funding: None.
Conflict of Interest: None of the authors have any conflicts of interest associated with the work presented in this manuscript.
Authorship: All authors had access to the data and played a role in writing this manuscript.