title: Aspirin in the treatment and prevention of cardiovascular disease.
abstract: Randomized trials of aspirin have been conducted in three main populations: patients with evolving acute myocardial infarction (MI), patients with a history of cardiovascular disease and apparently healthy subjects. Initiating aspirin therapy within 24 h after the onset of symptoms of an acute MI results in conclusive reductions in the risk of nonfatal reinfarction, nonfatal stroke and total cardiovascular death. In a wide range of patients with prior occlusive cardiovascular disease, aspirin reduces the risks of nonfatal MI, nonfatal stroke and vascular death. In primary prevention trials, aspirin has been shown to reduce the risk of a first MI in men; limited data make it difficult to draw conclusions regarding its effect on stroke and total cardiovascular death. Randomized data from studies in women and other populations are lacking. Until more data are available, the decision to use aspirin in primary prevention should be based on the clinical judgment of the physician and it should be used as an adjunct in the management of other cardiovascular disease risk factors.
authors.affiliation: Division of Preventive Medicine, Cardiovascular Division, and Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass 02215, USA. graziano@maveric.org
authors.forename: J M
authors.initials: JM
authors.lastname: Gaziano
authors.forename: P J
authors.initials: PJ
authors.lastname: Skerrett
authors.forename: J E
authors.initials: JE
authors.lastname: Buring
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000517:prevention & control*; D016022:Case-Control Studies; D015331:Cohort Studies; D003327:Coronary Disease / Q000188:drug therapy / Q000517:prevention & control; D003362:Cost-Benefit Analysis; D016861:Cyclooxygenase Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D016527:Drug Costs; D004348:Drug Labeling; D004363:Drug Utilization; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008297:Male; D015201:Meta-Analysis as Topic; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000401:mortality; D009204:Myocardial Revascularization; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D013300:Streptokinase / Q000627:therapeutic use; D020521:Stroke / Q000517:prevention & control; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000517:prevention & control; D016896:Treatment Outcome
chemical_list: D016861:Cyclooxygenase Inhibitors; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D013300:Streptokinase; D001241:Aspirin