Update on aspirin in the treatment and prevention of cardiovascular disease

The effects of low-dose aspirin on cardiovascular disease have been tested in randomized trials in 3 types of populations: (1) patients with a history of cardiovascular disease; (2) patients with evolving acute myocardial inf arction (MI), and (3) apparently healthy subjects. In a very wide range of patients with prior occlusive cardiovascular disease, aspirin reduces the r isks of nonfatal MI, nonfatal stroke, and vascular death. Initiating aspiri n therapy within 24 hours after the onset of symptoms of an acute MI also c onfers conclusive reductions in the risk of nonfatal reinfarction, nonfatal stroke, and total cardiovascular death. In primary prevention trials, aspi rin has been shown to reduce the risk of a first MI in men, but the data on stroke and total cardiovascular death are not sufficient to allow firm con clusions to be drawn; randomized data from studies in women are not yet ava ilable. The Women's Health Study an ongoing large-scale trial in Female hea lth core professionals, will provide the data necessary to assess the balan ce of benefits and risks of aspirin in primary prevention. Until then, the decision to use aspirin in primary prevention should be based on the clinic al judgment of the physician and considered as an adjunct in the management of other cardiovascular disease risk factors.