Aspirin for the Primary Prevention of Cardiovascular Events: A Summary of the Evidence for the U.S. Preventive Services Task Force

  1. Michael Hayden, MD, MPH;
  2. Michael Pignone, MD, MPH;
  3. Christopher Phillips, MD, MPH; and
  4. Cynthia Mulrow, MD, MSc
  1. From University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and Air Force Medical Operations Agency and University of Texas Health Science Center at San Antonio, San Antonio, Texas.
    1. Figure 1. BMD = British Male Doctors' Trial; HOT = Hypertension Optimal Treatment Trial; OR = odds ratio; PHS = Physicians' Health Study; PPP = Primary Prevention Project; TPT = Thrombosis Prevention Trial. The result of the chi-square test for heterogeneity was 8.07 ( = 0.089).
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      Figure 1. BMD = British Male Doctors' Trial; HOT = Hypertension Optimal Treatment Trial; OR = odds ratio; PHS = Physicians' Health Study; PPP = Primary Prevention Project; TPT = Thrombosis Prevention Trial. The result of the chi-square test for heterogeneity was 8.07 ( = 0.089). Meta-analysis of total coronary heart disease events.P
    2. Figure 2. Results of the chi-square test for heterogeneity were 2.96 for coronary heart disease mortality, 5.36 for fatal and nonfatal stroke events, and 1.58 for all-cause mortality ( > 0.2 in all cases). BMD = British Male Doctors' Trial; HOT = Hypertension Optimal Treatment Trial; OR = odds ratio; PHS = Physicians' Health Study; PPP = Primary Prevention Project; TPT = Thrombosis Prevention Trial.
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      Figure 2. Results of the chi-square test for heterogeneity were 2.96 for coronary heart disease mortality, 5.36 for fatal and nonfatal stroke events, and 1.58 for all-cause mortality ( > 0.2 in all cases). BMD = British Male Doctors' Trial; HOT = Hypertension Optimal Treatment Trial; OR = odds ratio; PHS = Physicians' Health Study; PPP = Primary Prevention Project; TPT = Thrombosis Prevention Trial. Meta-analysis of the effect of aspirin on coronary heart disease mortality (top), fatal and nonfatal stroke events (middle), and all-cause mortality (bottom).P
    3. Appendix (Figure 1). CHD = coronary heart disease; CVD = cardiovascular disease; KQ = key question. KQ 1: Does aspirin chemoprevention in patients without known cardiovascular disease reduce the risk for myocardial infarction, stroke, and death? KQ 2: Does aspirin chemoprevention increase major gastrointestinal bleeding, hemorrhagic strokes, or both? KQ 3: What is the balance of benefits and harms for aspirin therapy in patients with different levels of cardiovascular risk?
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      Appendix (Figure 1). CHD = coronary heart disease; CVD = cardiovascular disease; KQ = key question. KQ 1: Does aspirin chemoprevention in patients without known cardiovascular disease reduce the risk for myocardial infarction, stroke, and death? KQ 2: Does aspirin chemoprevention increase major gastrointestinal bleeding, hemorrhagic strokes, or both? KQ 3: What is the balance of benefits and harms for aspirin therapy in patients with different levels of cardiovascular risk? Analytic framework: aspirin to prevent cardiovascular events.
    4. Appendix (Figure 2). BMD = British Male Doctors' Trial; CVD = coronary vascular disease; ETDRS = Early Treatment Diabetic Retinopathy Study; HOT = Hypertension Optimal Treatment Trial; PHS = Physicians' Health Study; PPP = Primary Prevention Project; SAPAT = Swedish Angina Pectoris Aspirin Trial; TPT = Thrombosis Prevention Trial.
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      Appendix (Figure 2). BMD = British Male Doctors' Trial; CVD = coronary vascular disease; ETDRS = Early Treatment Diabetic Retinopathy Study; HOT = Hypertension Optimal Treatment Trial; PHS = Physicians' Health Study; PPP = Primary Prevention Project; SAPAT = Swedish Angina Pectoris Aspirin Trial; TPT = Thrombosis Prevention Trial. Search strategy: beneficial effects.
    5. Appendix (Figure 3).
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      Appendix (Figure 3). Search strategy: harmful effects.

    Summary for Patients

    • Summaries for Patients:Aspirin for the Prevention of Heart Attacks in People without Previous Cardiovascular Events: Recommendations from the United States Preventive Services Task Force Ann Intern Med January 15, 2002 136:I55
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    1. Ann Intern Med January 15, 2002 vol. 136 no. 2 161-172
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