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Review: aspirin reduces CAD events in people with no history of cardiovascular disease, but it increases gastrointestinal bleeding

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 QUESTION: What are the benefits and harm of aspirin use to prevent coronary artery disease (CAD) events in people with no history of cardiovascular disease?

Data sources

Studies were identified by searching Medline (1966 to May 2001), reviewing bibliographies of relevant studies and systematic reviews, and contacting experts.

Study selection

Randomised controlled trials (RCTs) of aspirin related benefits were selected if they compared aspirin with placebo or no aspirin; included participants with no history of cardiovascular disease; had a duration ≥ 1 year; and assessed myocardial infarction (MI), stroke, and mortality. Case control studies, RCTs, and systematic reviews of aspirin related harm were selected if they assessed haemorrhagic stroke or gastrointestinal (GI) bleeding.

Data extraction

Data were extracted on study year and location, duration of treatment, patient characteristics, aspirin dosage, control condition, and additional treatments. Quality of trials was assessed on the basis of …

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  • Source of funding: Agency for Healthcare Research and Quality.

  • For correspondence: Dr M Pignone, University of North Carolina Hospital, Chapel Hill, North Carolina, USA. pignone{at}