More Evidence to Help Guide Decision Making About Aspirin for Primary Prevention
Authors: Michael Pignone, Darren A. DeWalt
Journal: Annals of Internal Medicine (2019)

Letters16 July 2019More Evidence to Help Guide Decision Making About Aspirin for Primary PreventionMichael Pignone, MD, MPH and Darren A. DeWalt, MD, MPHMichael Pignone, MD, MPHDell Medical School, University of Texas, Austin, Texas (M.P.)Search for more papers by this author and Darren A. DeWalt, MD, MPHUniversity of North Carolina School of Medicine, Chapel Hill, North Carolina (D.A.D.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L19-0194 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:We did not intend to imply that the new evidence suggests that discontinuing aspirin therapy should be encouraged. Of note, we specifically differentiated the question of whether to initiate aspirin therapy (particularly in older adults) from whether to stop it. We believe that the newer evidence suggests caution when initiating this therapy in older adults but does not address whether to continue it in persons who tolerate it well. Those who are considering stopping aspirin therapy should be apprised of the risk associated with discontinuation (1).The newer trials do not contradict the idea that aspirin reduces nonfatal ...References1. 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 Scholar2. Zheng SL, Roddick AJ. Association of aspirin use for primary prevention with cardiovascular events and bleeding events: a systematic review and meta-analysis. JAMA. 2019;321:277-87. [PMID: 30667501] doi:10.1001/jama.2018.20578 CrossrefMedlineGoogle Scholar3. Pletcher MJ, Pignone M, Earnshaw S, et al. Using the coronary artery calcium score to guide statin therapy: a cost-effectiveness analysis. Circ Cardiovasc Qual Outcomes. 2014;7:276-84. [PMID: 24619318] doi:10.1161/CIRCOUTCOMES.113.000799 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Dell Medical School, University of Texas, Austin, Texas (M.P.)University of North Carolina School of Medicine, Chapel Hill, North Carolina (D.A.D.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-2637. 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 Arthur J. Siegel Metrics 16 July 2019Volume 171, Issue 2Page: 149KeywordsAspirinCardiovascular therapyCoronary artery calcificationDecision makingDisclosureElderlyHemorrhageMyocardial infarctionStatins ePublished: 16 July 2019 Issue Published: 16 July 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...