Several meta-analyses have focused on determination of the effectiveness of
aspirin (
acetylsalicylic acid) in primary prevention of cardiovascular (CV) events. Despite these data, the role of
aspirin in primary prevention continues to be investigated. Nine randomized trials have evaluated the benefits of
aspirin for the primary prevention of CV events: the British Doctors' Trial (BMD), the Physicians' Health Study (PHS), the
Thrombosis Prevention Trial (
TPT), the
Hypertension Optimal Treatment (HOT) study, the Primary Prevention Project (PPP), the Women's Health Study (WHS), the
Aspirin for Asymptomatic
Atherosclerosis Trial (AAAT), the Prevention of Progression of Arterial Disease and Diabetes (POPADAD) trial, and the Japanese Primary Prevention of
Atherosclerosis With
Aspirin for Diabetes (JPAD) trial. The combined sample consists of about 90,000 subjects divided approximately evenly between those taking
aspirin and subjects not taking
aspirin or taking placebo. A meta-analysis of these 9 trials assessed 6 CV end points: total
coronary heart disease, nonfatal
myocardial infarction (MI), total CV events,
stroke, CV mortality, and all-cause mortality. No covariate adjustment was performed, and appropriate tests for treatment effect, heterogeneity, and study size bias were applied. The meta-analysis suggested superiority of
aspirin for total CV events and nonfatal MI, (p <0.05 for each), with nonsignificant results for decreased risk for
stroke, CV mortality, and all-cause mortality. There was no evidence of a statistical bias (p >0.05). In conclusion,
aspirin decreased the risk for CV events and nonfatal MI in this large sample. Thus, primary prevention with
aspirin decreased the risk for total CV events and nonfatal MI, but there were no significant differences in the incidences of
stroke, CV mortality, all-cause mortality and total
coronary heart disease.