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Aspirin Ineffective in Primary Prevention of Stroke

There is no dispute about the benefits of aspirin for patients with previous vascular events. However, many patients with no history of vascular events also take aspirin preventively; the benefit in this setting (i.e., primary prevention) is less clear.

To determine the effect of aspirin in the primary prevention of stroke, these researchers performed a meta-analysis that included 5 placebo-controlled studies with a total of 52,251 subjects (mean age, 57) followed for an average of 4.6 years. Aspirin doses ranged from 75 to 650 mg/day. The overall rate of stroke was 0.3 percent per year; aspirin did not lower the stroke rate compared with placebo (relative risk, 1.08, a nonsignificant difference). Aspirin's failure to lower the rate of stroke was noted in analyses of subgroups with and without vascular risk factors. In contrast, aspirin significantly reduced the rate of MI (RR, 0.74); the base rate of myocardial infarction was 0.7 percent per year. Three of the 5 studies included only men.

Comment: This analysis suggests that aspirin is ineffective for primary prevention of stroke. Because of aspirin's tendency to increase the risk for major bleeding events, particularly in the elderly, the authors conclude that routine aspirin prophylaxis is not warranted in healthy elderly people. However, they favor prophylactic aspirin for middle-aged people at special risk for MI.

— AS Brett

Published in Journal Watch General Medicine March 28, 2000

Citation(s):

Hart RG et al. Aspirin for the primary prevention of stroke and other major vascular events: Meta-analysis and hypotheses. Arch Neurol 2000 Mar 57 326-332.

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