People Centric Approach in secondary prevention of cardiovascular disease: the absolute benefits of aspirin on occlusive events are greater than the absolute harm of major bleeding. All must get it.

Personal Centric Approach in primary prevention: the decision whether to use aspirin for primary prevention of cardiovascular disease and cancer be made based on shared decision-making, taking into account the probable benefits and harms of aspirin relative to the specific patient.

Three recent large randomized trials evaluating all-cause mortality associated with aspirin use indicate that the benefits and harms of aspirin for primary prevention are very closely balanced [1-5].

In both the ASCEND trial in patients with diabetes as well as the ARRIVE trial in patients with moderate CVD risk, the risk of all-cause death was similar with or without aspirin [1,5].

In the ASPREE trial of individuals 70 years or older, the risk of death was higher with aspirin (13 versus 11 percent) [2-4].

References

1. ASCEND Study Collaborative Group, Bowman L, Mafhac approachm M, et al. Effects of Aspirin for Primary Prevention in Persons with Diabetes Mellitus. N Engl J Med 2018; 379:1529.
2. McNeil JJ, Woods RL, Nelson MR, et al. Effect of Aspirin on Disability-free Survival in the Healthy Elderly. N Engl J Med 2018; 379:1499.
3. McNeil JJ, Wolfe R, Woods RL, et al. Effect of Aspirin on Cardiovascular Events and Bleeding in the Healthy Elderly. N Engl J Med 2018; 379:1509.
4. McNeil JJ, Nelson MR, Woods RL, et al. Effect of Aspirin on All-Cause Mortality in the Healthy Elderly. N Engl J Med 2018; 379:1519.
5. Gaziano JM, Brotons C, Coppolecchia R, et al. 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. Lancet 2018; 392:1036.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA