Routine use of aspirin not supported

by Poonam Singhal



The routine use of aspirin for the prevention of vascular events in people with asymptomatic disease cannot be supported, according to results from the Aspirin for Asymptomatic Atherosclerosis (AAA) study.

The study is designed to determine the effect of aspirin in asymptomatic atherosclerosis as reflected by a low ankle brachial index (ABI). Results found no statistically significant difference in primary endpoint events between those subjects allocated to aspirin or placebo.

Joint first author Professor Gerry Fowkes from the Wolfson Unit for Prevention of Peripheral Vascular Diseases in Edinburgh said: "It is possible that in the general population, aspirin could produce a smaller reduction in vascular events than this trial was designed to detect, but it is questionable whether such an effect, together with aspirin related morbidity, would justify the additional resources and health care requirements of an ABI screening programme."

The benefits of antiplatelet therapy in the prevention of future cardio- and cerebrovascular events is well established in patients with a clinical history of arterial vascular disease (secondary prevention); however, evidence in primary prevention is limited, with studies suggesting that any benefit of aspirin must be weighed against the risk of bleeding. The aim of the AAA trial was to determine the effectiveness of aspirin in preventing events in people with asymptomatic atherosclerosis detected by ABI screening.

The study recruited 28,980 men and women aged 50 to 75 years who were free of clinically evident cardiovascular disease in central Scotland; all were given an ABI screening test. Those with a low ABI were entered into the trial and randomised to once daily 100 mg aspirin or placebo. Participants were followed up for a mean of 8•2 years and outcomes ascertained by annual contact, general practitioner records, linkage to discharges from Scottish hospitals, and death notification.

Commenting on the results (and on the use of ABI as a screening method), Professor Fowkes said: "Although the AAA trial was not of screening per se, the results would suggest that using the ABI as a tool to screen individuals free of cardiovascular disease in the community is unlikely to be beneficial if aspirin is the intervention to be used in those found to be at higher risk. Other more potent antiplatelets might be considered, but only if increased effectiveness in avoiding ischaemic events is not matched by increased bleeding."


(Poonam Singhal -- sub-editor compiled and published Routine use of aspirin not supported at HealthNewsTrack on August 31, 2009 sourced from European Society of Cardiology - http://www.escardio.org/)

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