- •We studied the effect of aspirin on the prevention of cardiovascular diseases.
- •Its protective effects were regardless of age, sex, and underlying comorbidities.
- •The results were not significantly different from the recently changed guidelines of aspirin on primary prevention.
- •Nevertheless, periodic patient observation is required when using aspirin clinically, and it is necessary to prescribe it in consideration of advantages and disadvantages.
Background and aims
Although the guidelines have been revised recently, the effect of aspirin for the primary prevention of cardiovascular disease (CVD) is still controversial. Thus, we aimed to evaluate the effect of aspirin on primary prevention in the real world.
Among the 4,266,268 participants without a history of CVD or previous prescription of aspirin and other antiplatelet agents who were screened between 2002 and 2008, 268,963 persons who were prescribed low-dose aspirin (≤100 mg/day) over 90 days in 2002–2008 and 1,075,852 persons who did not receive aspirin were selected after propensity score matching. A Cox proportional-hazards model was used to evaluate the effect of low-dose aspirin on the development of CVD and bleeding episodes.
Aspirin showed a protective effect on total CVD events (hazard ratio; 0.737, 95% confidence interval; 0.729–0.745). The protective effect of aspirin on total CVD events was significant in men, women and even in young participants (<65 years). Aspirin had a protective effect in participants with diabetes or hypertension against all subcategories of CVD. The HR of bleeding risk was 1.4–1.5 in aspirin group.
Low-dose aspirin generally showed a protective effect against CVD regardless of age, sex, and underlying comorbidities in the real world. Though, the effect of aspirin was evident at a young age, the risk of bleeding was also high (1.4–1.5 times), and thus, careful prescription is required.
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Accepted: March 14, 2023
Received in revised form: March 2, 2023
Received: August 11, 2022
Publication stageIn Press Journal Pre-Proof
© 2023 Published by Elsevier B.V.