More Evidence to Help Guide Decision Making About Aspirin for Primary Prevention
Authors: Arthur J. Siegel
Journal: Annals of Internal Medicine (2019)

Letters16 July 2019More Evidence to Help Guide Decision Making About Aspirin for Primary PreventionArthur J. Siegel, MDArthur J. Siegel, MDMGH Internal Medicine Associates, McLean Hospital, Belmont, Massachusetts, and Harvard Medical School, Boston, Massachusetts (A.J.S.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L19-0193 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Pignone and DeWalt's (1) endorsement of reducing aspirin use for primary cardiovascular prevention in a low-risk general population should have advised primary care practitioners about the unexpected increase in acute cardiac events after this therapy is discontinued (2). The decrease in cardiovascular morbidity and mortality with low-dose aspirin in women at high risk for preterm preeclampsia in a placebo-controlled trial exemplifies the efficacy of such use in persons at above-average short-term risk (3). Aspirin use was associated with a 44% reduction in first acute myocardial infarctions in middle-aged men in a randomized controlled primary prevention trial (4). ...References1. Pignone M, DeWalt DA. More evidence to help guide decision making about aspirin for primary prevention. Ann Intern Med. 2018;169:804-5. [PMID: 30476933]. doi:10.7326/M18-2637 LinkGoogle Scholar2. Sundström J, Hedberg J, Thuresson M, et al. Low-dose aspirin discontinuation and risk of cardiovascular events: a Swedish nationwide, population-based cohort study. Circulation. 2017;136:1183-92. [PMID: 28947478] doi:10.1161/CIRCULATIONAHA.117.028321 CrossrefMedlineGoogle Scholar3. Rolnik DL, Wright D, Poon LC, et al. Aspirin versus placebo in pregnancies at high risk for preterm preeclampsia. N Engl J Med. 2017;377:613-22. [PMID: 28657417] doi:10.1056/NEJMoa1704559 CrossrefMedlineGoogle Scholar4. Steering Committee of the Physicians' Health Study Research Group. Final report on the aspirin component of the ongoing Physicians' Health Study. N Engl J Med. 1989;321:129-35. [PMID: 2664509] CrossrefMedlineGoogle Scholar5. Siegel AJ, Noakes TD. Aspirin to prevent sudden cardiac death in athletes with high coronary artery calcium scores. Am J Med. 2019;132:138-41. [PMID: 30296406] doi:10.1016/j.amjmed.2018.09.015 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: MGH Internal Medicine Associates, McLean Hospital, Belmont, Massachusetts, and Harvard Medical School, Boston, Massachusetts (A.J.S.)Disclosures: The author has disclosed no conflicts of interest. The form can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L19-0193. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoMore Evidence to Help Guide Decision Making About Aspirin for Primary Prevention Michael Pignone and Darren A. DeWalt More Evidence to Help Guide Decision Making About Aspirin for Primary Prevention Michael Pignone and Darren A. DeWalt Metrics 16 July 2019Volume 171, Issue 2Page: 148-149KeywordsAspirinConflicts of interestCoronary artery calcificationDecision makingDisclosureHeartMorbidityMortalityPreeclampsiaStable coronary artery disease ePublished: 16 July 2019 Issue Published: 16 July 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...