Aspirin prophylaxis in patients at low risk for cardiovascular disease: a systematic review of all-cause mortality.
OBJECTIVE
We investigated whether aspirin reduces all-cause mortality in low-risk patients.


METHODS
We systematically reviewed studies of aspirin for primary prevention to measure total mortality. We included all clinical trials, cohort studies, and case control studies that assessed primary prevention, included low-risk subjects, and measured total mortality. The quality of studies was evaluated with a standard scale.


METHODS
MEDLINE, the Cochrane Library, and the Internet were systematically searched for studies with the key terms primary, prevention, aspirin, myocardial infarction, stroke, and mortality. Reference lists of identified trials and reviews also were examined.


METHODS
Active members in the Indiana Academy of Family Physicians 2000-2001 membership database (N = 1328).


METHODS
Primary outcomes were myocardial infarction, stroke, and mortality.


RESULTS
Three primary prevention studies met our criteria. Two clinical trials, the United States Physicians Health Study and British Doctors Study, demonstrated no significant decrease in mortality in the aspirin group alone or when results from the 2 studies were combined. The United States Physicians Health Study showed a lower rate of myocardial infarction (odds ratio [OR], 0.58; 95% confidence interval [CI], 0.47-0.71). In the Nurses Health Study, a cohort study, taking aspirin at any dose was associated with higher rates of myocardial infarction (OR, 2.34; CI, 1.92-2.86), stroke (OR, 1.84; CI, 1.39-2.44), and all-cause mortality (OR, 1.83; CI, 1.57-2.14).


CONCLUSIONS
There is currently no evidence to recommend for or against the use of aspirin to decrease mortality in low-risk individuals.
Dept of Family Medicine, Mercer University School of Medicine, 3780 Eisenhower Parkway, Macon, GA 31206, USA. boltri.john@mccg.org
John M
JM
Boltri
Mark R
MR
Akerson
Robert L
RL
Vogel
D001241:Aspirin / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000401:mortality*; D006801:Humans; D018570:Risk Assessment
D001241:Aspirin