Determination of who may derive most benefit from aspirin in primary prevention: subgroup results from a randomised controlled trial.
OBJECTIVE
To determine which groups of patients may derive particular benefit or experience harm from the use of low dose aspirin for the primary prevention of coronary heart disease.


METHODS
Randomised controlled trial.


METHODS
108 group practices in the Medical Research Council's general practice research framework who were taking part in the thrombosis prevention trial.


METHODS
5499 men aged between 45 and 69 years at entry who were at increased risk of coronary heart disease.


METHODS
Myocardial infarction, coronary death, and stroke.


RESULTS
Aspirin reduced coronary events by 20%. This benefit, mainly for non-fatal events, was significantly greater the lower the systolic blood pressure at entry (interaction P=0.0015), the relative risk at pressures 130 mm Hg being 0.55 compared with 0.94 at pressures >145 mm Hg. Aspirin also reduced strokes at low but not high pressures, the relative risks being 0.41 and 1.42 (P=0.006) respectively. The relative risk of all major cardiovascular events-that is, the sum of coronary heart disease and stroke-was 0.59 at pressures <130 mm Hg compared with 1.08 at pressures >145 mm Hg (P=0.0001).


CONCLUSIONS
Even with the limitations of subgroup analyses the evidence suggests that the benefit of low dose aspirin in primary prevention may occur mainly in those with lower systolic blood pressures, although it is not clear even in these men that the benefit outweighs the potential hazards. Men with higher pressures may be exposed to the risks of bleeding while deriving no benefit through reductions in coronary heart disease and stroke.
Meade
T W
TW
MRC Epidemiology and Medical Care Unit, Wolfson Institute of Preventive Medicine, London, EC1M 6BQ. t.w.meade@mds.qmw.ac.uk
Brennan
P J
PJ
D000368:Aged; D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology / Q000517:prevention & control*; D018579:Patient Selection; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D012307:Risk Factors; D020521:Stroke / Q000503:physiopathology / Q000517:prevention & control*
D010975:Platelet Aggregation Inhibitors; D001241:Aspirin