Efficacy and safety of aspirin for primary prevention of cardiovascular events: a meta-analysis and trial sequential analysis of randomized controlled trials

Mahmoud, Ahmed N.; Gad, Mohamed M.; Elgendy, Islam Y.; Bavry, Anthony A.

doi:10.1093/eurheartj/ehy813

Cited by 146 publications

(122 citation statements)

References 30 publications

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“…153 This was further confirmed by sequential analysis, which also suggested the futility of conducting further trials to assess a benefit of aspirin on all-cause mortality. 154 The lack of benefit was evident even in people with DM and patients with high cardiovascular risk (i.e. 10year risk >7.5%).…”

Section: Antiplatelet Therapymentioning

confidence: 99%

Update on cardiovascular prevention in clinical practice: A position paper of the European Association of Preventive Cardiology of the European Society of Cardiology

Piepoli

Abreu

Albus

et al. 2019

Eur J Prev Cardiolog

181

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European guidelines on cardiovascular prevention in clinical practice were first published in 1994 and have been regularly updated, most recently in 2016, by the Sixth European Joint Task Force. Given the amount of new information that has become available since then, components from the task force and experts from the European Association of Preventive Cardiology of the European Society of Cardiology were invited to provide a summary and critical review of the most important new studies and evidence since the latest guidelines were published. The structure of the document follows that of the previous document and has six parts: Introduction (epidemiology and cost effectiveness); Cardiovascular risk; How to intervene at the population level; How to intervene at the individual level; Disease-specific interventions; and Settings: where to intervene? In fact, in keeping with the guidelines, greater emphasis has been put on a population-based approach and on disease-specific interventions, avoiding re-interpretation of information already and previously considered. Finally, the presence of several gaps in the knowledge is highlighted.

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Section: Antiplatelet Therapymentioning

confidence: 99%

Update on cardiovascular prevention in clinical practice: A position paper of the European Association of Preventive Cardiology of the European Society of Cardiology

Piepoli

Abreu

Albus

et al. 2019

Eur J Prev Cardiolog

181

View full text Add to dashboard Cite

show abstract

“…The prevention of progression of arterial disease and diabetes (POPADAD) trial of 1276 individuals with type 2 diabetes and evidence of peripheral vascular disease also failed to show benefits for aspirin, but again the study was underpowered [27]. Interestingly, an early meta‐analysis in 2009 of six studies, and more recent work in 2017 and 2018 including 10 and 11 trials respectively, failed to show convincing evidence for a beneficial effect of aspirin when used for primary prevention [28‐30]. However, these analyses included underpowered studies and used people from different periods with varying degrees of vascular protective therapies, thus questioning the contemporary applications of the findings.…”

Section: Primary Preventionmentioning

confidence: 99%

Antiplatelet therapies in diabetes

2020

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Cardiovascular complications remain the main cause of mortality and morbidity in diabetes. This is related to advanced vascular pathology in this population, together with an enhanced thrombotic environment. The increased risk in thrombosis is secondary to platelet hyper-reactivity and increased levels and/or altered activity of coagulation factors. The current review is focused on the role of antiplatelet agents in modulating the thrombotic milieu in diabetes and improving vascular outcome in this high-risk population. We review the latest evidence for the use of aspirin in primary vascular prevention together with long-term treatment with this agent for secondary prevention. We also discuss the effects of the various P2Y 12 inhibitors, including clopidogrel, prasugrel and ticagrelor, on both short-and long-term secondary vascular prevention. Moreover, we briefly review antiplatelet therapies in special groups of people including those intolerant to aspirin, individuals with peripheral vascular disease and those with cerebrovascular pathology. The overall aim of this review is to provide the healthcare professional with a pragmatic guide for the management of thrombotic risk using established antiplatelet therapies to improve vascular outcome in persons with diabetes.Diabet. Med. 37, 726-734 (2020) ª 2020 Diabetes UK

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“…This evidence‐based summary examines the benefits and harms of aspirin in patients without known CVD. For this purpose, we summarize the 2015 U.S. Preventive Services Task Force report and two recent systematic reviews of aspirin for primary prevention . The USPSTF report, published in 2016, was the definitive systematic review until three trials were published after its release.…”

Section: Narrativementioning

confidence: 99%

“…The ARRIVE, ASCEND, and ASPREE clinical trials together included over 47,000 new subjects. Two updated systematic reviews by Mahmoud et al . and Zheng et al .…”

Section: Narrativementioning

confidence: 99%