The DOI matches its Crossref record; 12 of the 12 references it cites were found in a registry or an index.
Association of Aspirin Use for Primary Prevention With Cardiovascular Events and Bleeding Events: A Systematic Review and Meta-analysis
Open accessAbstract
IMPORTANCE: The role for aspirin in cardiovascular primary prevention remains controversial, with potential benefits limited by an increased bleeding risk. OBJECTIVE: To assess the association of aspirin use for primary prevention with cardiovascular events and bleeding. DATA SOURCES: PubMed and Embase were searched on Cochrane Library Central Register of Controlled Trials from the earliest available date through November 1, 2018. STUDY SELECTION: Randomized clinical trials enrolling at least 1000 participants with no known cardiovascular disease and a follow-up of at least 12 months were included. Included studies compared aspirin use with no aspirin (placebo or no treatment). DATA EXTRACTION AND SYNTHESIS: Data were screened and extracted independently by both investigators. Bayesian and frequentist meta-analyses were performed. MAIN OUTCOMES AND MEASURES: The primary cardiovascular outcome was a composite of cardiovascular mortality, nonfatal myocardial infarction, and nonfatal stroke. The primary bleeding outcome was any major bleeding (defined by the individual studies). RESULTS: A total of 13 trials randomizing 164 225 participants with 1 050 511 participant-years of follow-up were included. The median age of trial participants was 62 years (range, 53-74), 77 501 (47%) were men, 30 361 (19%) had diabetes, and the median baseline risk of the primary cardiovascular outcome was 9.2% (range, 2.6%-15.9%). Aspirin use was associated with significant reductions in the composite cardiovascular outcome compared with no aspirin (57.1 per 10 000 participant-years with aspirin and 61.4 per 10 000 participant-years with no aspirin) (hazard ratio [HR], 0.89 [95% credible interval, 0.84-0.95]; absolute risk reduction, 0.38% [95% CI, 0.20%-0.55%]; number needed to treat, 265). Aspirin use was associated with an increased risk of major bleeding events compared with no aspirin (23.1 per 10 000 participant-years with aspirin and 16.4 per 10 000 participant-years with no aspirin) (HR, 1.43 [95% credible interval, 1.30-1.56]; absolute risk increase, 0.47% [95% CI, 0.34%-0.62%]; number needed to harm, 210). CONCLUSIONS AND RELEVANCE: The use of aspirin in individuals without cardiovascular disease was associated with a lower risk of cardiovascular events and an increased risk of major bleeding. This information may inform discussions with patients about aspirin for primary prevention of cardiovascular events and bleeding.
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Cites
Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement
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European Guidelines on cardiovascular disease prevention in clinical practice (version 2012)
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2016 European Guidelines on cardiovascular disease prevention in clinical practice
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A Randomized Trial of Low-Dose Aspirin in the Primary Prevention of Cardiovascular Disease in Women
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Effects of aspirin for primary prevention in persons with diabetes mellitus
The ASCEND Study Collaborative Group (2018) · New England Journal of Medicine · doi:10.1056/nejmoa1804988 · Cited by 1,200
Effect of Aspirin on Cardiovascular Events and Bleeding in the Healthy Elderly
McNeil, J. J., Wolfe, R., Woods, R. L., Tonkin, A. M., Donnan, G. A., Nelson, M. R., Reid, C. M., Lockery, J. E., Kirpach, B., Storey, E., et al. (2018) · New England Journal of Medicine · doi:10.1056/nejmoa1805819 · Cited by 1,139
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Cited by
2021 ESC Guidelines on cardiovascular disease prevention in clinical practice
Visseren, F. L. J., Mach, F., Smulders, Y. M., Carballo, D., Koskinas, K. C., Bäck, M., Benetos, A., Biffi, A., Boavida, J.-M., Capodanno, D., et al. (2021) · European Heart Journal · doi:10.1093/eurheartj/ehab484 · Cited by 6,485
Libby, P., Buring, J. E., Badimon, L., Hansson, G. K., Deanfield, J., Bittencourt, M. S., Tokgözoğlu, L., & Lewis, E. F. (2019) · Nature Reviews Disease Primers · doi:10.1038/s41572-019-0106-z · Cited by 3,211
Rabi, D. M., McBrien, K. A., Sapir-Pichhadze, R., Nakhla, M., Ahmed, S. B., Dumanski, S. M., Butalia, S., Leung, A. A., Harris, K. C., Cloutier, L., et al. (2020) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2020.02.086 · Cited by 583
Cardiovascular disease in type 2 diabetes mellitus: progress toward personalized management
Ma, C.-X., Ma, X.-N., Guan, C.-H., Li, Y.-D., Mauricio, D., & Fu, S.-B. (2022) · Cardiovascular Diabetology · doi:10.1186/s12933-022-01516-6 · Cited by 464
Cainzos-Achirica, M., Miedema, M. D., McEvoy, J. W., Al Rifai, M., Greenland, P., Dardari, Z., Budoff, M., Blumenthal, R. S., Yeboah, J., Duprez, D. A., et al. (2020) · Circulation · doi:10.1161/circulationaha.119.045010 · Cited by 201
Metadata
- Authors
- Zheng, S. L., & Roddick, A. J.
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2019-01-22
- Volume
- 321
- Issue
- 3
- Pages
- 277
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W2914972362
- Cited by
- 577
- References
- 12
- FWCI
- 54.45
- Type
- journal article
- Language
- en
- Open access
- bronze
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- Zheng, S. L., & Roddick, A. J. (2019). Association of Aspirin Use for Primary Prevention With Cardiovascular Events and Bleeding Events: A Systematic Review and Meta-analysis. JAMA. https://doi.org/10.1001/jama.2018.20578
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