Report from a scientific roundtable meeting held at the Royal Society of Medicine, London, in October 2009.
Aspirin was developed in 1897 but, despite many years of widespread use, the full therapeutic potential of acetylsalicylic acid (ASA) is still being uncovered and important uncertainties remain about its therapeutic role. Its efficacy in secondary prevention of cardiovascular disease is unchallenged but a recent meta-analysis has prompted questions about the place of low-dose aspirin as primary prevention of cardiovascular disease – in particular, about the balance of risk and benefit in people with diabetes.1
Some people do not derive the expected benefit from aspirin prophylaxis but we do not fully understand why this is the case.
This roundtable meeting, convened by the Aspirin Foundation and the British Journal of Cardiology, was sponsored by Bayer Health Care. It reviewed current knowledge about the role of aspirin in the management of cardiovascular disease.
Professor Peter Elwood (Department of Epidemiology, Cardiff University), who chaired the meeting, expressed concerns about the interpretation of recent data. He questioned whether the positive and negative outcomes observed with use of aspirin were compared fairly. There had been little consideration of the possible benefit of reducing bleeding risk by eradicating H. pylori and the potential reduction in cancer risk with long-term aspirin use was being ignored.
In his view, reporting of new evidence about aspirin in the lay media had been biased and negative, though his experience with citizens’ juries had convinced him that an educated and informed public can make rational decisions about the risks and benefits of treatment. There remains much to learn about the most effective ways of using aspirin, he concluded.
- Calvin AD, Aggarwal NR, Murad NH et al. Aspirin for the primary prevention of cardiovascular events: a systematic review and meta-analysis comparing patients with and without diabetes. Diabetes Care 2009 Sep 9; published online ahead of print.