The bottom line: We still don’t know if aspirin therapy lowers the rate of first heart attacks and strokes in people at moderate risk for cardiovascular events, according to ARRIVE study research presented at the European Society of Cardiology Congress 2018 and published in The Lancet.
While the benefits of daily aspirin for preventing second heart attacks and strokes is well established, aspirin therapy in people at increased risk for, but with no history of, cardiovascular events is controversial. Aspirin also raises the risk for abnormal bleeding.
In the ARRIVE study, researchers examined the effects of daily aspirin on heart attacks, strokes, and bleeding in 12,546 people at moderate cardiovascular risk, which is defined as a 20 to 30 percent risk for heart attack or stroke within 10 years. Men in the study were at least 55 years old and had two to four cardiovascular risk factors, such as smoking, high cholesterol, or high blood pressure, and women were at least 60 years old with three or more risk factors. Study participants took a 100-mg enteric-coated aspirin tablet daily or a placebo and were followed for an average of five years.
According to the researchers, aspirin therapy lowered heart attack risk — especially in people younger than 60 — but didn’t affect stroke risk. Side effects such as minor GI bleeding, abdominal pain, indigestion, and nosebleeds were common in study participants taking daily aspirin. Since the cardiovascular event rate was so much lower than expected, these results are most likely reflective of additional risk management strategies such as high blood pressure medication, statin drugs, etc. The role of aspirin in primary prevention among patients at true moderate risk could not be adequately addressed in this study and the results are consistent with previous low-risk prevention research.
Sourced from: The Lancet