Key Takeaway
Low-dose aspirin reduces major cardiovascular events in primary prevention but increases bleeding risk, with net benefit depending on individual cardiovascular risk profile.
Summary
This systematic review and meta-analysis pooled data from 13 randomized controlled trials involving over 164,000 participants to evaluate the benefits and risks of low-dose aspirin for primary prevention of cardiovascular disease. The analysis included trial sequential analysis (TSA) to assess the robustness of findings.
The results showed that low-dose aspirin significantly reduced the risk of major adverse cardiovascular events (MACE), myocardial infarction, and ischemic stroke in individuals without established cardiovascular disease. However, aspirin also significantly increased the risk of major bleeding events, including gastrointestinal and intracranial hemorrhage.
Trial sequential analysis confirmed that the evidence for both cardiovascular benefit and bleeding risk had crossed the monitoring boundaries, indicating firm conclusions. The authors concluded that the decision to use low-dose aspirin for primary prevention should involve careful individualized assessment, weighing cardiovascular risk reduction against bleeding risk.