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  • Aspirin prophylaxis (100 mg daily) does not improve cardiovascular outcomes compared to placebo in asymptomatic individuals with incidental low-ankle brachial index

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Therapeutics
Randomised controlled trial
Aspirin prophylaxis (100 mg daily) does not improve cardiovascular outcomes compared to placebo in asymptomatic individuals with incidental low-ankle brachial index
  1. S Marlene Grenon,
  2. Michael S Conte
  1. University of California, San Francisco, California, USA
  1. Correspondence to Dr S Marlene Grenon
    Vascular and Endovascular Surgery, Surgical Service (Mail Code 112 G), San Francisco VAMC, San Francisco, CA 94121, USA; marlene.grenon{at}ucsfmedctr.org

https://doi.org/10.1136/ebm1080

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    Commentary on:

    1. Fowkes FG,
    2. Price JF,
    3. Stewart MC,
    4. et al
    .; Aspirin for Asymptomatic Atherosclerosis Trialists. Aspirin for prevention of cardiovascular events in a general population screened for a low ankle brachial index: a randomized controlled trial. JAMA 2010;303:841–8.
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    Peripheral arterial disease: the beast

    Peripheral arterial disease (PAD) affects a large number of individuals around the globe and is associated with a three- to six-fold increased risk in cardiovascular morbidity and mortality.1 Patients suffering from PAD are considered to be at an exceptionally high risk for cardiovascular events, with cardiac and cerebrovascular events being the leading cause of mortality.2 3 Critical-limb ischemia is a particularly severe form of PAD, and once patients have progressed to that level, the morbidity, mortality and economic burden are even more considerable.4 5 The ankle-brachial index (ABI) is a simple, noninvasive test that can be done in the practitioner's office to identify patients with PAD.6 At the present time, it is recommended that patients with PAD be treated with antiplatelet and lipid-lowering agents, along with management of their hypertension, hyperglycemia and lifestyle modifications7 in order to reduce the risk of cardiovascular complications.

    An important contribution

    In this important contribution, Fowkes and colleagues aimed to determine the effectiveness of aspirin in preventing events in an asymptomatic patient population screened with low ABI. The Aspirin for Asymptomatic Atherosclerosis trial was an intention-to-treat double-blind randomised controlled trial that included men and women aged between 50 and 75 years, free of clinical cardiovascular disease and recruited from a community health registry. Between 1998 and 2008, 3350 patients with an ABI ≤0.95 entered the trial and were treated with …

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    Footnotes

    • Competing interests None.