CHICAGO — A new trial shows no benefit of low-dose, once-daily aspirin in the primary prevention of cardiovascular events in patients with multiple risk factors, including hypertension, diabetes, and dyslipidemia. No benefit was seen for the composite endpoint of nonfatal myocardial infarction (MI), nonfatal stroke, or death from cardiovascular causes. There were significant reductions in MI and in transient ischemic attack (TIA), but a significant increase in serious extracranial hemorrhage meant the net benefit was questionable. The overall rate of events was much lower than anticipated in this study, and it did not reach statistical significance, said study coauthor Kazuyuki Shimada, MD, Department of Cardiology, Shin-Oyama City Hospital, Tochigi, Japan. "Therefore, the possibility that aspirin does have a beneficial effect in this population cannot be excluded." Still, the clinical importance of aspirin for primary prevention was "less than originally anticipated in this population," he concluded, and further analyses are planned to see whether they can identify patients who may benefit most from aspirin. "Lastly, it will be interesting to see if the ongoing studies ARRIVE, ASCEND, ASPREE and ACCEPT-D, which are assessing primary prevention in predominantly Western populations, have different outcomes to our study in Japanese patients," Dr Shimada said. The results of the Japanese Primary Prevention Project (JPPP) were published online November 17 in JAMA to coincide with presentation here at the American Heart Association 2014 Scientific Sessions.
