Efficacy and safety of aspirin for primary prevention of cardiovascular events: a meta-analysis and trial sequential analysis of randomized controlled trials.


AIMS:The role of aspirin in the primary prevention setting is continuously evolving. Recent randomized trials have challenged the role of aspirin in the primary prevention setting. METHODS AND RESULTS:Electronic databases were searched for randomized trials that compared aspirin vs. placebo (or control) in subjects without established atherosclerotic disease. The primary efficacy outcome was all-cause mortality, while the primary safety outcome was major bleeding. Summary estimates were reported using a DerSimonian and Laird random effects model. A total of 11 trials with 157 248 subjects were included. At a mean follow-up of 6.6 years, aspirin was not associated with a lower incidence of all-cause mortality [risk ratio (RR) 0.98, 95% confidence interval (CI) 0.93-1.02; P = 0.30]; however, aspirin was associated with an increased incidence of major bleeding (RR 1.47, 95% CI 1.31-1.65; P < 0.0001) and intracranial haemorrhage (RR 1.33, 95% CI 1.13-1.58; P = 0.001). A similar effect on all-cause mortality and major bleeding was demonstrated in diabetic and high cardiovascular risk patients (i.e. 10-year risk >7.5%). Aspirin was associated with a lower incidence of myocardial infarction (RR 0.82, 95% CI 0.71-0.94; P = 0.006); however, this outcome was characterized by considerable heterogeneity (I2 = 67%), and this effect was no longer evident upon limiting the analysis to the more recent trials. Trial sequential analysis confirmed the lack of benefit of aspirin for all-cause mortality up to a relative risk reduction of 5%. CONCLUSION:Among adults without established cardiovascular disease, aspirin was not associated with a reduction in the incidence of all-cause mortality; however, it was associated with an increased incidence of major bleeding. The routine use of aspirin for primary prevention needs to be reconsidered.


Eur Heart J


European heart journal


Mahmoud AN,Gad MM,Elgendy AY,Elgendy IY,Bavry AA




Has Abstract


2019-02-14 00:00:00














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    abstract:AIMS:Increasing evidence supports a role for inflammation in promoting atrial fibrillation (AF) and statins have anti-inflammatory effects that may be relevant for the prevention of AF. However, studies of statin therapy and incident AF have yielded mixed results and not focused on individuals with an underlying pro-in...

    journal_title:European heart journal

    pub_type: 杂志文章,随机对照试验


    authors: Peña JM,MacFadyen J,Glynn RJ,Ridker PM

    更新日期:2012-02-01 00:00:00

  • High-sugar feeding and increasing cholesterol levels in infants.

    abstract::Hypercholesterolaemia is an important risk factor for cardiovascular disease. Both total and LDL cholesterol levels are three-fold higher at the end of the first year of life and about four-fold higher in adulthood compared with the neonatal period. In the USA, only 25% of infants are exclusively breastfed and simple ...

    journal_title:European heart journal

    pub_type: 杂志文章


    authors: Zubin Maslov P,Hill JA,Lüscher TF,Narula J

    更新日期:2020-12-16 00:00:00

  • Physiological variation in the termination window of re-entry tachycardia studied by non-invasive programmed stimulation.

    abstract::In seven patients with re-entry tachycardias and the implanted antitachycardia device Tachylog (Siemens Elema, Sweden) the variation in the termination window related to posture and exertion was investigated. The investigations were performed on an outpatient basis utilizing the interactive pacing mode of the implante...

    journal_title:European heart journal

    pub_type: 杂志文章


    authors: Schmidinger H,Sowton E

    更新日期:1988-09-01 00:00:00

  • Modulation of the interleukin-6 signalling pathway and incidence rates of atherosclerotic events and all-cause mortality: analyses from the Canakinumab Anti-Inflammatory Thrombosis Outcomes Study (CANTOS).

    abstract:Aims:Canakinumab, a monoclonal antibody targeting interleukin (IL)-1β, reduces rates of recurrent cardiovascular events without lowering lipids. It is uncertain, however, to what extent these beneficial cardiovascular outcomes are mediated through interleukin-6 (IL-6) signalling, an issue with substantial pathophysiolo...

    journal_title:European heart journal

    pub_type: 杂志文章,随机对照试验


    authors: Ridker PM,Libby P,MacFadyen JG,Thuren T,Ballantyne C,Fonseca F,Koenig W,Shimokawa H,Everett BM,Glynn RJ

    更新日期:2018-10-07 00:00:00

  • Exercise echocardiography performed early and late after percutaneous transluminal coronary angioplasty for prediction of restenosis.

    abstract::The purpose of this prospective study was to examine the incidence of exercise-induced ischaemia before and after angioplasty as well as 4 months later by exercise echocardiography, to evaluate the prognostic value of exercise echocardiography performed after angioplasty as regards the development of restenosis and to...

    journal_title:European heart journal

    pub_type: 杂志文章


    authors: Hoffmann R,Lethen H,Flachskampf FA,Hanrath P

    更新日期:1995-12-01 00:00:00

  • Leptin is an endothelial-independent vasodilator in humans with coronary artery disease: Evidence for tissue specificity of leptin resistance.

    abstract:AIMS:We sought to define the mechanisms and correlates of leptin's vascular actions in humans with coronary artery disease. METHODS AND RESULTS:In 131 patients (age 65.7+/-0.7 years mean+/-SEM), ex vivo vascular reactivity to leptin (10(-13)-10(-7) M) was assessed in saphenous vein (SV) rings. Leptin led to SV relaxat...

    journal_title:European heart journal

    pub_type: 杂志文章


    authors: Momin AU,Melikian N,Shah AM,Grieve DJ,Wheatcroft SB,John L,El Gamel A,Desai JB,Nelson T,Driver C,Sherwood RA,Kearney MT

    更新日期:2006-10-01 00:00:00

  • Arrhythmogenic right ventricular cardiomyopathy caused by deletions in plakophilin-2 and plakoglobin (Naxos disease) in families from Greece and Cyprus: genotype-phenotype relations, diagnostic features and prognosis.

    abstract:AIMS:To evaluate clinical disease expression, non-invasive diagnosis, and prognosis in families with dominant vs. recessive arrhythmogenic right ventricular cardiomyopathy (ARVC) due to mutations in related desmosomal proteins plakophilin-2 (PKP2) and plakoglobin (JUP), respectively. METHODS AND RESULTS:One hundred an...

    journal_title:European heart journal

    pub_type: 杂志文章


    authors: Antoniades L,Tsatsopoulou A,Anastasakis A,Syrris P,Asimaki A,Panagiotakos D,Zambartas C,Stefanadis C,McKenna WJ,Protonotarios N

    更新日期:2006-09-01 00:00:00

  • Surgical treatment of active infective aortic valve endocarditis with associated periannular abscess--11 year results.

    abstract:AIMS:The aim of the study was to evaluate the long-term results of allograft and prosthetic valve replacement in the treatment of infective aortic valve endocarditis with periannular abscess. METHODS:Between March 1988 and March 1996, 65 patients underwent surgery for active aortic valve endocarditis and paravalvular ...

    journal_title:European heart journal

    pub_type: 杂志文章


    authors: Knosalla C,Weng Y,Yankah AC,Siniawski H,Hofmeister J,Hammerschmidt R,Loebe M,Hetzer R

    更新日期:2000-03-01 00:00:00

  • Comparative study of human-induced pluripotent stem cells derived from bone marrow cells, hair keratinocytes, and skin fibroblasts.

    abstract:AIMS:Induced pluripotent stem cells (iPSCs) provide a unique opportunity for the generation of patient-specific cells for use in disease modelling, drug screening, and regenerative medicine. The aim of this study was to compare human-induced pluripotent stem cells (hiPSCs) derived from different somatic cell sources re...

    journal_title:European heart journal

    pub_type: 杂志文章


    authors: Streckfuss-Bömeke K,Wolf F,Azizian A,Stauske M,Tiburcy M,Wagner S,Hübscher D,Dressel R,Chen S,Jende J,Wulf G,Lorenz V,Schön MP,Maier LS,Zimmermann WH,Hasenfuss G,Guan K

    更新日期:2013-09-01 00:00:00

  • Effects of nisoldipine on left ventricular function during exercise or cold pressor stress.

    abstract::The effects of a single oral dose of nisoldipine, 10 mg, were investigated in two groups of patients. Firstly, the effects of nisoldipine on exercise left ventricular function were assessed in 20 patients with chronic stable angina and coronary disease. Secondly, the effects of nisoldipine on the left ventricular resp...

    journal_title:European heart journal

    pub_type: 杂志文章


    authors: Dymond DS,Caplin JL,O'Keefe JC,Banim S

    更新日期:1987-11-01 00:00:00

  • The association of long-term outcome and biological sex in patients with acute heart failure from different geographic regions.

    abstract:AIMS:Recent data from national registries suggest that acute heart failure (AHF) outcomes might vary in men and women, however, it is not known whether this observation is universal. The aim of this study was to evaluate the association of biological sex and 1-year all-cause mortality in patients with AHF in various re...

    journal_title:European heart journal

    pub_type: 杂志文章


    authors: Motiejūnaitė J,Akiyama E,Cohen-Solal A,Maggioni AP,Mueller C,Choi DJ,Kavoliūnienė A,Čelutkienė J,Parenica J,Lassus J,Kajimoto K,Sato N,Miró Ò,Peacock WF,Matsue Y,Voors AA,Lam CSP,Ezekowitz JA,Ahmed A,Fonarow GC,Ga

    更新日期:2020-04-01 00:00:00

  • Use of coronary angiography and revascularization procedures following acute myocardial infarction. A European perspective.

    abstract:AIMS:There is little evidence to inform routine practice in the use of coronary angiography and revascularization procedures after acute myocardial infarction. Large differences in the uptake of these procedures have been reported but representative data are scarce. Outcome studies have produced opposing conclusions co...

    journal_title:European heart journal

    pub_type: 杂志文章,meta分析


    authors: Woods KL,Ketley D,Agusti A,Hagn C,Kala R,Karatzas NB,Leizorowicz A,Reikvam A,Schilling J,Seabra-Gomes R,Vasiliauskas D,Wilhelmsen L

    更新日期:1998-09-01 00:00:00

  • Ischaemic cardiac outcomes in patients with atrial fibrillation treated with vitamin K antagonism or factor Xa inhibition: results from the ROCKET AF trial.

    abstract:AIMS:We investigated the prevalence of prior myocardial infarction (MI) and incidence of ischaemic cardiovascular (CV) events among atrial fibrillation (AF) patients. METHODS AND RESULTS:In ROCKET AF, 14 264 patients with nonvalvular AF were randomized to rivaroxaban or warfarin. The key efficacy outcome for these ana...

    journal_title:European heart journal

    pub_type: 杂志文章,多中心研究,随机对照试验


    authors: Mahaffey KW,Stevens SR,White HD,Nessel CC,Goodman SG,Piccini JP,Patel MR,Becker RC,Halperin JL,Hacke W,Singer DE,Hankey GJ,Califf RM,Fox KA,Breithardt G,ROCKET AF Investigators.

    更新日期:2014-01-01 00:00:00

  • Prophylaxis of respiratory tract infection in patients on artificial respiration.

    abstract::In a pilot study, a prophylactic regimen including ciprofloxacin and amphotericin B was applied in 102 consecutive patients on artificial respiration for greater than or equal to 5 days to prevent respiratory tract infection with aerobic Gram-negative bacilli. Ciprofloxacin was given twice a day, as 500 mg through a g...

    journal_title:European heart journal

    pub_type: 杂志文章


    authors: Haverkorn MJ

    更新日期:1989-12-01 00:00:00

  • Percutaneous edge-to-edge MitraClip therapy in the management of mitral regurgitation.

    abstract::MitraClip therapy consists of percutaneous edge-to-edge coaptation of the mitral leaflets that is analogous to the surgical Alfieri technique. The safety profile of the MitraClip device is favourable, and survival outcomes in high-surgical-risk patients are superior to historical controls. However, questions remain re...

    journal_title:European heart journal

    pub_type: 杂志文章,评审


    authors: Rogers JH,Franzen O

    更新日期:2011-10-01 00:00:00

  • Clinical and economic impact of exercise electrocardiography and exercise echocardiography in clinical practice.

    abstract:BACKGROUND:Patients with known or suspected coronary disease are often investigated to facilitate risk assessment. We sought to examine the cost-effectiveness of strategies based on exercise echocardiography and exercise electrocardiography. METHODS AND RESULTS:We studied 7656 patients undergoing exercise testing; of ...

    journal_title:European heart journal

    pub_type: 杂志文章


    authors: Marwick TH,Shaw L,Case C,Vasey C,Thomas JD

    更新日期:2003-06-01 00:00:00

  • Fibroblast activation protein is induced by inflammation and degrades type I collagen in thin-cap fibroatheromata.

    abstract:AIMS:Collagen degradation in atherosclerotic plaques with thin fibrous caps renders them more prone to rupture. Fibroblast activation protein (FAP) plays a role in arthritis and tumour formation through its collagenase activity. However, the significance of FAP in thin-cap human fibroatheromata remains unknown. METHOD...

    journal_title:European heart journal

    pub_type: 杂志文章


    authors: Brokopp CE,Schoenauer R,Richards P,Bauer S,Lohmann C,Emmert MY,Weber B,Winnik S,Aikawa E,Graves K,Genoni M,Vogt P,Lüscher TF,Renner C,Hoerstrup SP,Matter CM

    更新日期:2011-11-01 00:00:00

  • Investigation of impaired coronary vasodilator reserve in the guinea pig heart with pressure induced hypertrophy.

    abstract::Impaired coronary reserve and increased minimal coronary resistance have been documented in several animal models of left ventricular hypertrophy. There is controversy whether the increased minimal coronary resistance is due to vascular or extravascular causes. To test the hypothesis that pressure-overloaded left vent...

    journal_title:European heart journal

    pub_type: 杂志文章,评审


    authors: O'Gorman DJ,Thomas P,Turner MA,Sheridan DJ

    更新日期:1992-05-01 00:00:00

  • The codex of science: honesty, precision, and truth--and its violations.

    abstract::Science has made enormous achievements for our understanding of the world and for everyday life: we now know that we live on a spherical planet of the solar system, we understand the origin of the species, we can take a train, survive myocardial infarction, and fly to the moon. This has been made possible thanks to a ...

    journal_title:European heart journal

    pub_type: 历史文章,杂志文章


    authors: Lüscher TF

    更新日期:2013-04-01 00:00:00

  • Major regional disparities in outcomes after sudden cardiac arrest during sports.

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    journal_title:European heart journal

    pub_type: 杂志文章


    authors: Marijon E,Bougouin W,Celermajer DS,Perier MC,Benameur N,Lamhaut L,Karam N,Dumas F,Tafflet M,Prugger C,Mustafic H,Rifler JP,Desnos M,Le Heuzey JY,Spaulding CM,Avillach P,Cariou A,Empana JP,Jouven X

    更新日期:2013-12-01 00:00:00

  • Elevation of asymmetric dimethylarginine in patients with unstable angina and recurrent cardiovascular events.

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    journal_title:European heart journal

    pub_type: 杂志文章


    authors: Krempl TK,Maas R,Sydow K,Meinertz T,Böger RH,Kähler J

    更新日期:2005-09-01 00:00:00

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    journal_title:European heart journal

    pub_type: 杂志文章,多中心研究,随机对照试验


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    更新日期:2011-12-01 00:00:00

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    journal_title:European heart journal

    pub_type: 杂志文章


    authors: Hess A,Derlin T,Koenig T,Diekmann J,Wittneben A,Wang Y,Wester HJ,Ross TL,Wollert KC,Bauersachs J,Bengel FM,Thackeray JT

    更新日期:2020-10-01 00:00:00

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    journal_title:European heart journal

    pub_type: 杂志文章,多中心研究


    authors: Shah SJ,Lam CSP,Svedlund S,Saraste A,Hage C,Tan RS,Beussink-Nelson L,Ljung Faxén U,Fermer ML,Broberg MA,Gan LM,Lund LH

    更新日期:2018-10-01 00:00:00

  • Adequacy of endogenous erythropoietin levels and mortality in anaemic heart failure patients.

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    journal_title:European heart journal

    pub_type: 杂志文章,多中心研究


    authors: van der Meer P,Lok DJ,Januzzi JL,de la Porte PW,Lipsic E,van Wijngaarden J,Voors AA,van Gilst WH,van Veldhuisen DJ

    更新日期:2008-06-01 00:00:00

  • Greater decreases in cholesterol levels among individuals with high cardiovascular risk than among the general population: the northern Sweden MONICA study 1994 to 2014.

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    journal_title:European heart journal

    pub_type: 杂志文章


    authors: Eriksson M,Forslund AS,Jansson JH,Söderberg S,Wennberg M,Eliasson M

    更新日期:2016-07-01 00:00:00

  • The impact of cachexia on cardiorespiratory reflex control in chronic heart failure.

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    journal_title:European heart journal

    pub_type: 杂志文章


    authors: Ponikowski P,Piepoli M,Chua TP,Banasiak W,Francis D,Anker SD,Coats AJ

    更新日期:1999-11-01 00:00:00

  • Intramyocardial injection of vascular endothelial growth factor-A165 plasmid followed by granulocyte-colony stimulating factor to induce angiogenesis in patients with severe chronic ischaemic heart disease.

    abstract:AIMS:To assess the safety and effects of combined treatment with vascular endothelial growth factor-A(165) plasmid (VEGF-A(165)) and granulocyte- colony stimulating factor (G-CSF) mobilization of bone marrow stem cells in patients with severe chronic ischaemic heart disease (IHD). METHODS AND RESULTS:Sixteen patients ...

    journal_title:European heart journal

    pub_type: 杂志文章,随机对照试验


    authors: Ripa RS,Wang Y,Jørgensen E,Johnsen HE,Hesse B,Kastrup J

    更新日期:2006-08-01 00:00:00

  • Observations on the capability of the electrocardiogram to detect left ventricular function in chronic severe aortic regurgitation.

    abstract::Echocardiographic parameters of left ventricular (LV) function were compared with the electrocardiographic findings in 40 patients with chronic severe aortic regurgitation. Total 12-lead QRS amplitude was linearly correlated with LV mass and its 'relative reduction' (less than 250 mm) indicated LV hypertrophy. Patient...

    journal_title:European heart journal

    pub_type: 杂志文章


    authors: Scognamiglio R,Fasoli G,Bruni A,Dalla-Volta S

    更新日期:1988-01-01 00:00:00

  • Effects of the new class III antiarrhythmic drug dofetilide on the atrial and ventricular intracardiac monophasic action potential in patients with angina pectoris.

    abstract::The class III antiarrhythmic drug dofetilide is known to prolong action potential duration by specific blockade of the delayed rectifier potassium channel Ik. As dofetilide is likely to be used in the treatment of atrial arrhythmias it is important to determine the relative sensitivity of the atrium and ventricle in m...

    journal_title:European heart journal

    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Sedgwick ML,Dalrymple I,Rae AP,Cobbe SM

    更新日期:1995-11-01 00:00:00