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At present, there is no consensus on antiplatelet treatments in primary prevention, particularly for women. European guidelines on cardiovascular disease (CVD) prevention1 do not recommend antiplatelet therapy, while the American Heart Association guidelines for primary prevention2 support a daily treatment of low-dose aspirin in women aged >65 years. The US Food and Drug Administration at the beginning of this year stated that the agency “does not believe the evidence supports the general use of aspirin for primary prevention of a heart attack or stroke. In fact, there are serious risks associated with the use of aspirin, including increased risk of bleeding in the stomach and brain, in situations where the benefit of aspirin for primary prevention has not been established”. A meta-analysis including nine controlled and randomised clinical trials (CRCT)3 well-summarised major evidences holding such endorsements: the risk reduction of 20% for non-fatal myocardial infarction in the aspirin treatment group corresponding to a number-needed-to-treat (NNT) of 162 did not balance the 31% increased risk of ‘non-trivial’ bleeding events with a number needed to harm (NNH) equal to 73.
For a more comprehensive understanding of the balance between benefits and harms of aspirin treatment, we need to take into account recent scientific reports on the protective effect of acetyl salicylic acid (ASA) with respect to some forms of cancer. Evidences from both CRCT and observational studies lead to conclude that a daily use of low-dose aspirin has a clear protective effect on colorectal and other gastrointestinal cancers in healthy people even if …
Contributors MMF wrote the editorial and GV provided support for the interpretation of the statistical analysis and helped in writing.
Competing interests None.
Provenance and peer review Commissioned; internally peer reviewed.