Use of aspirin to reduce risk of initial vascular events in patients at moderate risk of cardiovascular disease (ARRIVE): a randomised, double-blind, placebo-controlled trial

Gaziano, J. Michael; Brotons, Carlos; Coppolecchia, Rosa; Cricelli, Claudio; Darius, Harald; Gorelick, Philip B.; Howard, George; Pearson, Thomas A.; Rothwell, Peter M.; Ruilope, Luis; Tendera, Michał; Tognoni, Gianni

doi:10.1016/s0140-6736(18)31924-x

Cited by 698 publications

(677 citation statements)

References 24 publications

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“…However, controversies have been existed about whether, and if so in whom, aspirin is appropriate for the primary prevention of CVD till the recent three trials of low‐dose aspirin versus placebo in populations at increased risk but without established CVD were reported. In the ARRIVE trial for people at low risk of CVD, aspirin had no effect on major CV events but increased gastrointestinal bleeding . In the ASCEND trial for patients with diabetes mellitus and no evidence of vascular disease, the benefits of aspirin on serious vascular events reduction were totally offset by the increased risk of major bleeding .…”

Section: Management Of Associated Cvd Risk Factorsmentioning

confidence: 99%

Expert consensus on the management of hypertension in the young and middle‐aged Chinese population

Liu

Chen

et al. 2019

Int J Clin Pract

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Summary Background and purposeThe increased prevalence of hypertension, along with obesity, dyslipidemia, and type 2 diabetes in the young and middle‐aged population has become a major global public health issue. Although more attention has been paid to the management of hypertension and cardiovascular disease (CVD) risks in elderly patients nationally and internationally, there is currently no consensus worldwide on appropriate evaluation and treatment of hypertension in younger subjects. We developed the consensus and aimed to provide a comprehensive strategy for the management of hypertension in young and middle‐aged population. MethodsThe authors and experts of the Hypertension Group of the 10th committee of Chinese Society of Cardiology reviewed the available literature and evidence on the pathophysiological characteristics of hypertension, CVD risk assessments and antihypertensive therapies, discussed and reached an agreement on recommendations. Disccussions and recommendationsThe pathophysiological and clinical characteristics of hypertension in young and middle‐aged patients are vastly different from those observed in the elderly. In particular, the sympathetic nervous system (SNS) and the renin‐angiotensin system (RAS) are significantly activated in this population. Global CVD risk assessment should be performed as determinants of initiating anti‐hypertensive therapy. A blood pressure (BP) target of <140/90 mm Hg should be achieved first on BP‐lowering therapies, with an ultimate BP <130/80 mm Hg for most patients, if tolerated. Initiating BP‐lowering therapies with a beta‐blocker or RAS inhibitor (angiotensin‐converting enzyme inhibitor or angiotensin II receptor blocker), or in combination with calcium channel blocker or diuretic in high CVD risk patients, along with active lifestyle changes, are preferred. ConclusionsAn aggressive and comprehensive BP and CVD risk management strategy should be implemented in the young and middle‐aged hypertensive population.

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Section: Management Of Associated Cvd Risk Factorsmentioning

confidence: 99%

Expert consensus on the management of hypertension in the young and middle‐aged Chinese population

Liu

Chen

et al. 2019

Int J Clin Pract

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“…Since the submission of this letter for publication three modern trials of primary preventative aspirin have been published. Aspirin was associated with no cardiovascular benefit in the elderly, but low‐risk (3.45–3.88% 5‐year event‐rate) ASPirin in Reducing Events in the Elderly (ASPREE) population (hazard ratio (HR) 0.95, 95% CI 0.83–1.08, P > 0.05) or the low‐to‐moderate‐risk (4.29–4.48% 5‐year event‐rate) Aspirin to Reduce Risk of Initial Vascular Events (ARRIVE) trial (HR 0.96, 95% CI 0.81–1.13, P = 0.604) . The high‐risk (8.5–9.6% 7.4‐year event‐rate) A Study of Cardiovascular Events iN Diabetes (ASCEND) trial did show a benefit (RR 0.88, 95% CI 0.79–0.97, P = 0.01), but at the cost of increased major bleeding (RR 1.29, 95% CI 1.09–1.52, P = 0.003) .…”

mentioning

confidence: 99%

Aspirin for primary cardiovascular disease prevention: time to re‐evaluate guidelines?

Barmanray

Hamblin

2019

Internal Medicine Journal

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“…The ASPREE trial was in healthy elderly subjects, and the ARRIVE trial was in subjects at moderate risk of cardiovascular disease. The results of the three studies were broadly similar …”

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confidence: 52%

Results of the ASCEND study: time to abandon aspirin for the primary prevention of cardiovascular disease in people with diabetes

2019

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Use of aspirin to reduce risk of initial vascular events in patients at moderate risk of cardiovascular disease (ARRIVE): a randomised, double-blind, placebo-controlled trial

Abstract: Bayer.

Cited by 698 publications

References 24 publications

Expert consensus on the management of hypertension in the young and middle‐aged Chinese population

Expert consensus on the management of hypertension in the young and middle‐aged Chinese population

Aspirin for primary cardiovascular disease prevention: time to re‐evaluate guidelines?

Results of the ASCEND study: time to abandon aspirin for the primary prevention of cardiovascular disease in people with diabetes

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