The Efficacy And Safety Of Aspirin As The Primary Prevention Of Cardiovascular Disease: An Updated Meta-Analysis

Figures & data

Figure 1 The PRISMA flow diagram.

Figure 2 Assessment of the risk of bias of the included studies.

Table 1 The Characteristics Of The Included Studies

Study	The Name Of Study	Country	Number Of Subjects	Inclusion Criterial	Mean Age (Years)	Male (%)	Weight (kg)	BMI (kg/m^2)	Diabetes (%)	Aspirin Dose	Mean Follow-Up (Years)
Gaziano et al, 2018^Citation12	ARRIVE	Seven countries	12, 546	55 years (men) or 60 years (women) and older and had an average cardiovascular risk, deemed to be moderate on the basis of the number of specific risk factors.	63.9	70.5	82	28.4	0	Enteric-coated aspirin tablets (100 mg) once daily	5
McNeil et al, 2018^Citation11	ASPREE	Australia and the United States	19,114	70 years of age or older(or ≥65 years of age among blacks and Hispanics in the United States) and did not have cardiovascular disease, dementia, or disability.	74	44	NA	28.1	10.8	100 mg of enteric-coated aspirin once daily	4.7
Bowman et al, 2018^Citation10	ASCEND	United Kingdom	15,480	Men and women at least 40 years of age were considered to be eligible if they had received a diagnosis of diabetes mellitus (any type) and did not have known cardiovascular disease	63.3	62.6	NA	30.7	94.1	Aspirin at a dose of 100 mg once daily	7.4
Sacco et al, 2001^Citation5	PPP	Italy	4, 495	People with at least one already known major cardiovascular risk factor	64.4	42	NA	NA	17	100 mg enteric-coated aspirin a day	3.6
Fowkes et al, 2010^Citation22	AAA	United Kingdom	3, 350	Men and women aged 50 to 75 years at baseline with no history of vascular disease.	62	29	NA	NA	3	Once daily 100 mg aspirin (enteric coated)	8.2
Saito et al, 2017^Citation23	JPAD	Japan	2, 539	Type 2 diabetes without a history of atherosclerotic disease	65	54	NA	24	100	Low-dose aspirin group (81 or 100 mg per day)	4.37
Ikeda et al, 2014^Citation6	JPPP	Japan	14, 658	Aged 60 to 85 years and had not been diagnosed with atherosclerotic disease	70.6	42.4	58.7	24.2	33.9	Enteric-coated aspirin 100mg/d	6.5
Belch et al, 2008^Citation21	POPADAD	United Kingdom	1, 276	Aged 40 or more with type 1 or type 2 diabetes and an ankle brachial pressure index of 0.99 or less but no symptomatic cardiovascular disease	60.1	42	NA	29	100	Once Daily, 100 mg aspirin tablet	6.7
Ridker et al, 2005^Citation7	WHS	United states	39,876	Women were eligible if they were 45 years of age or older; had no history of coronary heart disease, cerebrovascular disease and cancer	54.6	0	NA	26	2.6	100 mg of aspirin	10.1
Kassoff et al, 1992^Citation26	ETDRS	United states	3, 711	Ages of 18 and 70 years with a clinical diagnosis of diabetes mellitus	NA	56	NA	NA	100	650mg tablets once daily	5
Belanger et al, 1989^Citation25	PHSI	United states	22, 071	Male physicians aged 40–84 y	NA	100	NA	NA	NA	325 mg every day, tablet, not enteric-coated	5
Meade et al, 1998^Citation20	TPT	United Kingdom	2, 540	Men aged between 45 years and 69 years at high risk of ischemic heart disease	57.5	100	NA	27.4	NA	Aspirin was given as 75 mg a day in a controlled-release formulation.	6.8
Peto et al, 1988^Citation24	BMD	United Kingdom	5, 139	Healthy male doctors	NA	100	NA	NA	2.0	500 mg aspirin daily	6
Hansson et al, 1998^Citation4	HOT	26 countries	18, 790	Aged 50–80 years (mean 61·5 years) with hypertension and diastolic blood pressure between 100 mm Hg and 115 mm Hg (mean 105 mm Hg)	61.5	53	NA	28.5	8.0	75 mg/day aspirin	3.8

Figure 3 Benefit of aspirin for all-cause mortality.

Figure 4 Benefit of aspirin for cardiovascular mortality.

Figure 5 Benefit of aspirin for myocardial infarction.

Figure 6 Benefit of aspirin for stroke.

Figure 7 Safety of aspirin for major bleeding.

Figure 8 Safety of aspirin for gastrointestinal bleeding.

Figure 9 Safety of aspirin for hemorrhagic stroke.

Figure 10 The funnel plot in the meta-analysis.

Table 2 The Results Of Subgroup Analysis

The Variable	Estimated Relative Treatment Effects RR(95% CI)
Age
<65 years	0.95 (0.88–1.02)
≥65 years	1.06 (0.97–1.15)
Gender
The percentage of male was 100%	1.06 (0.97–1.15)
Others	0.98 (0.93–1.03)
The dosage of aspirin
≤100 mg/d	0.99 (0.94–1.05)
>100 mg/d	0.93 (0.84–1.02)
BMI
<28 kg/m^2	0.97 (0.89–1.05)
≥28 kg/m^2	1.04 (0.96–1.13)
DM
The percentage of DM was 100%	0.98 (0.93–1.03)
Others	0.99 (0.93–1.04)

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