title: A systematic review of aspirin in primary prevention: is it time for a new approach?
abstract: OBJECTIVE
  While evidence in support of aspirin use in secondary prevention is well documented, the role of aspirin in primary prevention remains unclear. We conducted a systematic literature review to evaluate aspirin use in cardiovascular disease (CVD) and cancer primary prevention, and consider whether aspirin's role is set to become more clearly defined based on past and prospective studies.
  
  
  METHODS
  Utilizing PubMed, the reviewers identified appropriate Medical Subject Headings (MeSH) terms to establish CVD-based studies, cancer-based studies, and studies on adherence.
  
  
  METHODS
  Date restrictions of May 31, 2008 to May 31, 2013 were applied to capture the most robust meta-analyses and randomized controlled trials. Websites of relevant EU and US scientific societies were used to identify the key guidelines for aspirin use in primary prevention of CVD, and ClinicalTrials.gov was used to establish future or ongoing trials.
  
  
  RESULTS
  Evidence in support of aspirin prophylaxis is conflicting, though some meta-analyses have underlined potential benefit in reducing cardiovascular events. Despite this apparent benefit, bleeding risk with aspirin is consistently higher versus control, and remains a concern. A reduction of cancer incidence and mortality after a least 3 and 5 years treatment, respectively, is also apparent with aspirin.
  
  
  CONCLUSIONS
  Available data on aspirin in primary prevention suggest a modest benefit for patients at high risk of CVD, and a promising benefit for those at risk of cancer. Future studies should help to elucidate whether the benefit of aspirin outweighs risk in appropriate patient groups.
authors.affiliation: Research Unit, Sardenya Primary Health Care Center, Biomedical Research Institute Sant Pau. Teaching Unit of Family Medicine ACEBA, Sardenya 466, 08025, Barcelona, Spain, cbrotons@eapsardenya.cat.
authors.forename: Carlos
authors.initials: C
authors.lastname: Brotons
authors.forename: Robert
authors.initials: R
authors.lastname: Benamouzig
authors.forename: Krzysztof J
authors.initials: KJ
authors.lastname: Filipiak
authors.forename: Volker
authors.initials: V
authors.lastname: Limmroth
authors.forename: Claudio
authors.initials: C
authors.lastname: Borghi
mesh_terms: D001241:Aspirin / Q000008:administration & dosage*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D011322:Primary Prevention / Q000379:methods / Q000639:trends*; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D013997:Time Factors
chemical_list: D010975:Platelet Aggregation Inhibitors; D001241:Aspirin