Evaluation of: Berger JS, Krantz MJ, Kittelson JM, Hiatt WR.
Aspirin for the prevention of cardiovascular events in patients with
peripheral artery disease: a meta-analysis of randomized trials. JAMA 301, 1909-1919 (2009).
Aspirin decreases the risk of cardiovascular events in patients with prior coronary heart or
cerebrovascular disease. The American College of Cardiology/American Heart Association guidelines recommend a low-dose
aspirin regimen (75-325 mg/day) to reduce the risk of cardiovascular events in patients with
peripheral artery disease (PAD). However, the effect of
aspirin for
secondary prevention in patients with PAD has not been well established. The paper under evaluation performed a meta-analysis of 18 trials to investigate the effect of
aspirin on cardiovascular events (nonfatal
myocardial infarction, nonfatal
stroke and cardiovascular death) in patients with PAD. The results of this meta-analysis in a PAD cohort revealed that treatment with
aspirin did not significantly reduce the combined end point of cardiovascular events; however,
aspirin resulted in a significant reduction in the incidence of nonfatal
stroke. This analysis raises a number of questions regarding the overall efficacy of
aspirin in PAD and what should be the optimal antiplatelet
therapy in patients with PAD:
aspirin,
clopidogrel or perhaps a combination of
aspirin and
clopidogrel.