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Primary cardiovascular prevention: in the absence of risk factors, aspirin is not advisable

Aspirin has a very limited role to play in primary cardiovascular prevention. A Mediterranean diet, stopping smoking, and the control of risk factors (hypertension and hypercholesterolaemia) are the best preventive measures.

Available evidence from clinical trials shows that people with no cardiovascular history should not take aspirin to prevent a first thrombotic event: it reduces the risk very slightly at the cost of an increased bleeding risk.

Aspirin probably reduces the frequency of stroke in women and heart attack in men, but at the cost of an increase in bleeding events. In the over-65 age group, aspirin increases the risk of cerebral haemorrhage which is already higher with age, and offers no benefits with regard to reducing mortality. In adults with high blood pressure, diabetics or smokers with no cardiovascular history, there is no evidence that aspirin reduces either overall mortality or cardiovascular mortality.

The greater the cardiovascular risk, the greater the benefit of aspirin in preventing severe thrombotic events, but the greater the bleeding risk too. The patient should be involved in making the decision whether to take it or not.

The best way of preventing an initial cardiovascular event is to adopt a Mediterranean-style diet and stop smoking, with control of cardiovascular risk factors (hypertension, hypercholesterolaemia).

©Prescrire November 2010

"Aspirin and primary cardiovascular prevention" Prescrire Int 2010; 19 (110): 258-261. (Pdf, subscribers only).

 
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