Conference Coverage
Aspirin fails to protect elderly at-risk patients from cardiac events
Key clinical point: Low-dose aspirin may not prevent adverse cardiovascular outcomes in patients with atherosclerotic risk factors. Major finding...
CHICAGO – Once-daily, low-dose aspirin failed to reduce the combined outcome of cardiovascular death, nonfatal stroke, and nonfatal MI in elderly Japanese patients with atherosclerotic risk factors in the JPPP study.
The cumulative rate of the composite primary outcome was 2.77% with 100 mg/day of aspirin and 2.96% with no aspirin (HR, 0.94; P = .54), Dr. Kazuyuki Shimada reported at the American Heart Association scientific sessions.
However, patients randomized to aspirin did have reductions of 47% and 43% in the individual endpoints of nonfatal MI and transient ischemic attack, respectively.
These benefits had to be weighed against an 85% increase in serious extracranial hemorrhage in those on aspirin, according to results of the Japanese Primary Prevention Project (JPPP), simultaneously published online in JAMA (doi:10.1001/jama.2014.15690).
How generalizable are these results, and is this the end of the road for aspirin in primary prevention? We asked several experts, including invited discussant Dr. Dorairaj Prabhakaran of the Public Health Foundation of India, Dr. Karol Watson of the UCLA Center for Cholesterol and Lipid Management, and Dr. Donald Lloyd-Jonesof Northwestern University in Chicago.
The study was sponsored by the Japanese Ministry of Health, Labor, and Welfare, and the Waksman Foundation of Japan. Bayer Yakuhin provided the aspirin. Dr. Shimada reported honorarium from MSD, Shionogi, Takeda, Daiichi-Sankyo, and Dainippon-Sumitomo, and serving as a consultant/advisory board member for Omron.
Dr. Prabhakaran and Dr. Jones reported no conflicting interests. Dr. Watson reported participating in the clinical trials adjudication committee for Merck.