Aspirin for the primary prevention of cardiovascular events

Graeme J Hankey and John W Eikelboom
Med J Aust 2002; 177 (7): . || doi: 10.5694/j.1326-5377.2002.tb04833.x
Published online: 7 October 2002

Benefits depend on the patient’s absolute cardiovascular and bleeding risks

The benefit of aspirin for patients with previous symptomatic atherothrombosis of the heart, brain and limb in the secondary prevention of recurrent serious vascular events is well established. However, the role of aspirin in the primary prevention of cardiovascular disease among people who have no symptoms of vascular disease is controversial.1 A recent summary of the evidence has prompted recommendations from the third US Preventive Services Task Force2,3 and the American Heart Association.4

  • Royal Perth Hospital, Perth, WA.


  • 1. Antithrombotic Trialists' Collaboration. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ 2002; 324: 71-86.
  • 2. US Preventive Services Task Force. Aspirin for the primary prevention of cardiovascular events: recommendation and rationale. Ann Intern Med 2002; 136: 157-160.
  • 3. Hayden M, Pignone M, Phillips C, Mulrow C. Aspirin for the primary prevention of cardiovascular events: a summary of the evidence for the US Preventive Services Task Force. Ann Intern Med 2002; 136: 161-172.
  • 4. Pearson TA, Blair SN, Daniels SR, et al. AHA guidelines for primary prevention of cardiovascular disease and stroke: 2002 update. Consensus panel guide to comprehensive risk reduction for adult patients without coronary or other atherosclerotic vascular diseases. Circulation 2002; 106: 388-391.
  • 5. Peto R, Gray R, Collins R, et al. Randomised trial of prophylactic daily aspirin in British male doctors. BMJ 1988; 296: 313-316.
  • 6. Steering Committee of the Physicians' Health Study Research Group. Final report on the aspirin component of the ongoing Physicians' Health Study. N Engl J Med 1989; 321: 129-135.
  • 7. The Medical Research Council's General Practice Research Framework. Thrombosis prevention trial: randomised trial of low-intensity oral anticoagulation with warfarin and low-dose aspirin in the primary prevention of ischaemic heart disease in men at increased risk. Lancet 1998; 351: 233-241.
  • 8. Hansson L, Zanchetti AZ, Carruthers SG, et al, for the HOT Study Group. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. Lancet 1998; 351: 1755-1762.
  • 9. Low-dose aspirin and vitamin E in people at cardiovascular risk: a randomised trial in general practice. Collaborative Group of the Primary Prevention Project. Lancet 2001; 357: 89-95.
  • 10. Sudlow C. What is the role of antithrombotic treatment in asymptomatic people? In: Clinical evidence. 6th issue. London: BMJ Publishing Group, December 2001: 101-102.
  • 11. Cardiovascular risk assessment tool. Available at:>. Accessed 6 September 2002.
  • 12. New Zealand cardiovascular risk calculator. National Prescribing Service Limited. Available at: <>. Accessed 6 September 2002.
  • 13. Lauer MS. Aspirin for primary prevention of coronary events. N Engl J Med 2002; 346: 1468-1474.


remove_circle_outline Delete Author
add_circle_outline Add Author

Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Online responses are no longer available. Please refer to our instructions for authors page for more information.