Aspirin for Primary Cardiovascular Prevention in Patients with Family History of Cardiovascular Disease: Meta-analysis
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LETTER TO THE EDITOR
Aspirin for Primary Cardiovascular Prevention in Patients with Family History of Cardiovascular Disease: Meta-analysis Miguel M. Antunes 1 & Mariana Alves 2,3,4 & Joaquim J. Ferreira 2,3,5 & Fausto J. Pinto 6 & Daniel Caldeira 2,6 Accepted: 8 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Letter to the Editor: The use of aspirin, while well established in the secondary prevention of cardiovascular events, remains controversial in the primary prevention of these events in the general adult population [1]. In this setting, aspirin showed a significant but modest decrease of cardiovascular event incidence at the cost of a significantly increased risk of bleeding, a pattern that is also seen in higher risk patients, such as diabetics [2]. It becomes exceedingly important to identify other patient clusters that would benefit from cardiovascular risk reduction at the best benefit/risk ratio. One significant group that is missing from landmark analyses is the one with family history of early cardiovascular disease, which is known to be an independent risk factor for the occurrence of cardiovascular events according to the American Heart Association (AHA)/American College of Cardiology (ACC) [3]. We proposed to systematically evaluate the impact of aspirin vs placebo/no aspirin in randomized controlled trials enrolling
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10557-020-07093-8) contains supplementary material, which is available to authorized users. * Daniel Caldeira [email protected] 1
Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
2
Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
3
Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
4
Serviço de Medicina III, Hospital Pulido Valente, CHULN, Lisbon, Portugal
5
CNS – Campus Neurológico Sénior, Torres Vedras, Portugal
6
Serviço de Cardiologia, Hospital Universitário de Santa Maria (CHULN), CAML, Centro Cardiovascular da Universidade de Lisboa - CCUL, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisbon, Portugal
patients with family history of cardiovascular disease. MEDLINE, CENTRAL, and Embase were comprehensively searched for aspirin trials in primary prevention (Supplementary Online) [2]. There were no language or time restrictions. In order to quantify the effect of aspirin, we performed a random effects model meta-analysis, using RevMan 5.3 and based on the raw data from the three included studies. Estimates were reported as risk ratio [RR] and 95% confidence interval [95% CI]. Statistical heterogeneity was assessed through I2 statistics. After removal of duplicates, 14 studies were yielded, three of which presented data referring to our population of interest—Japanese Primary Prevention Project (JPPP), Women's Health Study (WHS), and Physicians' Health Study (PHS) [4–6]. Any card
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