RT Journal
A1 Berger JS
T1 ASpirin as preventive therapy in patients with asymptomatic vascular disease
JF JAMA
JO JAMA
YR 2010
FD March 3
VO 303
IS 9
SP 880
OP 882
DO 10.1001/jama.2010.223
UL http://dx.doi.org/10.1001/jama.2010.223
AB 
Antiplatelet therapy has long been a cornerstone in the prevention and treatment of CVD. In a systematic overview and meta-analysis, the Antiplatelet Trialists' Collaboration demonstrated that antiplatelet therapy was associated with reduced rates of myocardial infarction (MI), stroke, and death.2 The strong data that support aspirin as a therapeutic intervention are in the setting of acute MI or stroke. In the Second International Study of Infarct Survival (ISIS-2), which included patients with suspected MI, aspirin reduced the rate of early vascular mortality by 23% vs placebo (P < .001).3 Similarly, a combined analysis of 2 large stroke trials (International Stroke Trial and Chinese Acute Stroke Trial) found that low-dose aspirin was associated with a significant reduction in recurrent ischemic stroke and mortality.4 A meta-analysis of 6 trials involving patients with symptomatic stable CVD demonstrated a consistent association between aspirin therapy and reduction of cardiovascular morbidity and mortality.5 These benefits of aspirin in patients with established CVD, along with the low cost of aspirin therapy, have been extrapolated to high-risk patients without established CVD in an effort to reduce the risk of cardiovascular events. However, preventive therapy presupposes a threat that can be averted at an acceptable risk. In the case of aspirin, the major risk is bleeding.