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Systematic review with meta analysis
Aspirin reduces cardiovascular events in primary prevention of cardiovascular disease but at a near equivalent risk of increased bleeding
  1. Michael D Miedema1,
  2. Salim S Virani2
  1. 1Minneapolis Heart Institute, Minneapolis, Minnesota, USA
  2. 2Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas, USA
  1. Correspondence to : Professor Salim S Virani, Health Services Research and Development (152), 2002 Holcombe Boulevard, Houston, TX 77030, USA; virani{at}

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The use of aspirin in primary prevention of cardiovascular disease (CVD) remains controversial, as randomised controlled trials (RCTs) have produced mixed results. Recently, the United States Preventive Services Task Force (USPSTF) published updated recommendations on the use of aspirin for primary prevention of CVD and colorectal cancer.1 This systematic review and meta-analysis served as the basis for these USPSTF recommendations for primary CVD prevention.


All trials from the previous 2009 USPSTF guideline on the use of aspirin for primary CVD prevention (minimum of 75 mg every other day for 1 year or more) in adults aged 40 or more were included, and a comprehensive literature search for additional trials from January 2008 to …

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  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.