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Annual Review of Medicine

Volume 72, 2021

Aspirin in the Prevention of Cardiovascular Disease and Cancer

Abstract

More than a century after its synthesis, daily aspirin, given at a low dose, is a milestone treatment for the secondary prevention of cardiovascular disease (CVD). Its role in primary prevention of CVD is still debated. Older randomized controlled trials showed that aspirin reduced the low incidence of myocardial infarction but correspondingly increased the low incidence of serious gastrointestinal bleeds without altering mortality. More recent trials see the benefit attenuated, perhaps obscured by other cardioprotective practices, while the bleeding risk remains, especially in older patients. Indirect evidence, both preclinical and clinical, suggests that aspirin may protect against sporadic colorectal cancer and perhaps other cancers. However, further studies are still necessary to warrant the consumption of aspirin for primary prevention of CVD and cancer by apparently healthy individuals.

Keyword(s): aspirin, cancer, cardiovascular disease, prevention
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/content/journals/10.1146/annurev-med-051019-102940
2021-01-27
2024-04-24
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Literature Cited

  1. 1. 
    Smith WL, DeWitt DL, Garavito RM 2000. Cyclooxygenases: structural, cellular, and molecular biology. Annu. Rev. Biochem. 69:145–82
     [Google Scholar]
  2. 2. 
    Clarke RJ, Mayo G, Price P, FitzGerald GA 1991. Suppression of thromboxane A2 but not of systemic prostacyclin by controlled-release aspirin. N. Engl. J. Med. 325:1137–41
     [Google Scholar]
  3. 3. 
    Patrignani P, Filabozzi P, Patrono C 1983. Low-dose aspirin is a selective inhibitor of platelet cyclooxygenase activity in healthy subjects. Adv. Prostaglandin Thromboxane Leukotriene Res. 11:259–64
     [Google Scholar]
  4. 4. 
    Baigent C, Blackwell L, Collins R et al. 2009. Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet 373:1849–60
     [Google Scholar]
  5. 5. 
    Patrono C, Baigent C. 2019. Role of aspirin in primary prevention of cardiovascular disease. Nat. Rev. Cardiol. 16:675–86
     [Google Scholar]
  6. 6. 
    Bowman L, Mafham M, Wallendszus K et al. 2018. Effects of aspirin for primary prevention in persons with diabetes mellitus. N. Engl. J. Med. 379:1529–39
     [Google Scholar]
  7. 7. 
    McNeil JJ, Nelson MR, Woods RL et al. 2018. Effect of aspirin on all-cause mortality in the healthy elderly. N. Engl. J. Med. 379:1519–28
     [Google Scholar]
  8. 8. 
    McNeil JJ, Woods RL, Nelson MR et al. 2018. Effect of aspirin on disability-free survival in the healthy elderly. N. Engl. J. Med. 379:1499–508
     [Google Scholar]
  9. 9. 
    McNeil JJ, Wolfe R, Woods RL et al. 2018. Effect of aspirin on cardiovascular events and bleeding in the healthy elderly. N. Engl. J. Med. 379:1509–18
     [Google Scholar]
  10. 10. 
    Gaziano JM, Brotons C, Coppolecchia R et al. 2018. Use of Aspirin to Reduce Risk of Initial Vascular Events in Patients at Moderate Risk of Cardiovascular Disease (ARRIVE): a randomised, double-blind, placebo-controlled trial. Lancet 392:1036–46
     [Google Scholar]
  11. 11. 
    Patrignani P, Patrono C. 2016. Aspirin and cancer. J. Am. Coll. Cardiol. 68:967–76
     [Google Scholar]
  12. 12. 
    Patrignani P, Patrono C. 2018. Aspirin, platelet inhibition and cancer prevention. Platelets 29:779–85
     [Google Scholar]
  13. 13. 
    Katona BW, Weiss JM. 2020. Chemoprevention of colorectal cancer. Gastroenterology 158:368–88
     [Google Scholar]
  14. 14. 
    Langley RE, Burdett S, Tierney JF et al. 2011. Aspirin and cancer: Has aspirin been overlooked as an adjuvant therapy. Br. J. Cancer 105:1107–13
     [Google Scholar]
  15. 15. 
    Hybiak J, Broniarek I, Kiryczyński G, Los LD, Rosik J et al. 2020. Aspirin and its pleiotropic application. Eur. J. Pharmacol. 866:172762
     [Google Scholar]
  16. 16. 
    Montinari MR, Minelli S, De Caterina R 2019. The first 3500 years of aspirin history from its roots—a concise summary. Vasc. Pharmacol. 113:1–8
     [Google Scholar]
  17. 17. 
    Grootveld M, Halliwell B. 1988. 2,3-Dihydroxybenzoic acid is a product of human aspirin metabolism. Biochem. Pharmacol. 37:271–80
     [Google Scholar]
  18. 18. 
    Vane JR. 1971. Inhibition of prostaglandin synthesis as a mechanism of action for aspirin-like drugs. Nat. New Biol. 231:232–35
     [Google Scholar]
  19. 19. 
    Pedersen AK, FitzGerald GA. 1984. Dose-related kinetics of aspirin. Presystemic acetylation of platelet cyclooxygenase. N. Engl. J. Med. 311:1206–11
     [Google Scholar]
  20. 20. 
    Loll PJ, Picot D, Garavito RM 1995. The structural basis of aspirin activity inferred from the crystal structure of inactivated prostaglandin H2 synthase. Nat. Struct. Biol. 2:637–43
     [Google Scholar]
  21. 21. 
    Lucido MJ, Orlando BJ, Vecchio AJ, Malkowski MG 2016. Crystal structure of aspirin-acetylated human cyclooxygenase-2: insight into the formation of products with reversed stereochemistry. Biochemistry 55:1226–38
     [Google Scholar]
  22. 22. 
    Patrono C. 2016. Cardiovascular effects of nonsteroidal anti-inflammatory drugs. Curr. Cardiol. Rep. 18:25
     [Google Scholar]
  23. 23. 
    Patrono C, Rocca B. 2009. Aspirin, 110 years later. J. Thromb. Haemost. 7:Suppl. 1258–61
     [Google Scholar]
  24. 24. 
    Brunton LL, Hilal-Dandan R, Knollman BC 2018. Goodman & Gilman's The Pharmacological Basis of Therapeutics New York: McGraw Hill. , 13th ed..
  25. 25. 
    De Berardis G, Lucisano G, D'Ettorre A et al. 2012. Association of aspirin use with major bleeding in patients with and without diabetes. JAMA 307:2286–94
     [Google Scholar]
  26. 26. 
    Fanaroff AC, Roe MT. 2016. Contemporary reflections on the safety of long-term aspirin treatment for the secondary prevention of cardiovascular disease. Drug Saf 39:715–27
     [Google Scholar]
  27. 27. 
    Bordeaux BC, Qayyum R, Yanek LR et al. 2010. Effect of obesity on platelet reactivity and response to low-dose aspirin. Prev. Cardiol. 13:56–62
     [Google Scholar]
  28. 28. 
    Rocca B, Santilli F, Pitocco D et al. 2012. The recovery of platelet cyclooxygenase activity explains interindividual variability in responsiveness to low-dose aspirin in patients with and without diabetes. J. Thromb. Haemost. 10:1220–30
     [Google Scholar]
  29. 29. 
    Dragani A, Pascale S, Recchiuti A et al. 2010. The contribution of cyclooxygenase-1 and -2 to persistent thromboxane biosynthesis in aspirin-treated essential thrombocythemia: implications for antiplatelet therapy. Blood 115:1054–61
     [Google Scholar]
  30. 30. 
    Pedersen AK, FitzGerald GA. 1985. The human pharmacology of platelet inhibition: pharmacokinetics relevant to drug action. Circulation 72:1164–76
     [Google Scholar]
  31. 31. 
    Capodanno D, Patel A, Dharmashankar K et al. 2011. Pharmacodynamic effects of different aspirin dosing regimens in type 2 diabetes mellitus patients with coronary artery disease. Circ. Cardiovasc. Interv. 4:180–87
     [Google Scholar]
  32. 32. 
    Rocca B, Tosetto A, Betti S et al. 2020. A randomized, double-blind trial of 3 aspirin regimens to optimize antiplatelet therapy in essential thrombocythemia. Blood 136:2171–82
     [Google Scholar]
  33. 33. 
    Tefferi A, Vannucchi AM, Barbui T 2018. Essential thrombocythemia treatment algorithm 2018. Blood Cancer J 8:2
     [Google Scholar]
  34. 34. 
    De Stefano V, Rocca B, Tosetto A et al. 2018. The Aspirin Regimens in Essential Thrombocythemia (ARES) phase II randomized trial design: implementation of the serum thromboxane B2 assay as an evaluation tool of different aspirin dosing regimens in the clinical setting. Blood Cancer J 8:49
     [Google Scholar]
  35. 35. 
    Rothwell PM, Cook NR, Gaziano JM et al. 2018. Effects of aspirin on risks of vascular events and cancer according to bodyweight and dose: analysis of individual patient data from randomised trials. Lancet 392:387–99
     [Google Scholar]
  36. 36. 
    Elwood PC, Cochrane AL, Burr ML et al. 1974. A randomized controlled trial of acetyl salicylic acid in the secondary prevention of mortality from myocardial infarction. BMJ 1:436–40
     [Google Scholar]
  37. 37. 
    Coronary Drug Proj. Res. Group 1980. Aspirin in coronary heart disease. The Coronary Drug Project Research Group. Circulation 62:V59–62
     [Google Scholar]
  38. 38. 
    Breddin K, Loew D, Lechner K et al. 1980. The German-Austrian aspirin trial: a comparison of acetylsalicylic acid, placebo and phenprocoumon in secondary prevention of myocardial infarction. On behalf of the German-Austrian Study Group. Circulation 62:V63–72
     [Google Scholar]
  39. 39. 
    Elwood PC, Sweetnam PM. 1979. Aspirin and secondary mortality after myocardial infarction. Lancet 2:1313–15
     [Google Scholar]
  40. 40. 
    Aspirin Myocardial Infarction Study Res. Group 1980. A randomized, controlled trial of aspirin in persons recovered from myocardial infarction. JAMA 243:661–69
     [Google Scholar]
  41. 41. 
    Persantine-Aspirin Reinfarction Study Res. Group 1980. Persantine and aspirin in coronary heart disease. The Persantine-Aspirin Reinfarction Study Research Group. Circulation 62:449–61
     [Google Scholar]
  42. 42. 
    Lancet 1980. Aspirin after myocardial infarction. Lancet 1:1172–73
     [Google Scholar]
  43. 43. 
    Lewis HD Jr, Davis JW, Archibald DG et al. 1983. Protective effects of aspirin against acute myocardial infarction and death in men with unstable angina. Results of a Veterans Administration Cooperative Study. N. Engl. J. Med. 309:396–403
     [Google Scholar]
  44. 44. 
    Cairns JA, Gent M, Singer J et al. 1985. Aspirin, sulfinpyrazone, or both in unstable angina. Results of a Canadian multicenter trial. N. Engl. J. Med. 313:1369–75
     [Google Scholar]
  45. 45. 
    Vejar M, Fragasso G, Hackett D et al. 1990. Dissociation of platelet activation and spontaneous myocardial ischemia in unstable angina. Thromb. Haemost. 63:163–68
     [Google Scholar]
  46. 46. 
    Fitzgerald DJ, Catella F, Roy L, FitzGerald GA 1988. Marked platelet activation in vivo after intravenous streptokinase in patients with acute myocardial infarction. Circulation 77:142–50
     [Google Scholar]
  47. 47. 
    Kerins DM, Roy L, FitzGerald GA, Fitzgerald DJ 1989. Platelet and vascular function during coronary thrombolysis with tissue-type plasminogen activator. Circulation 80:1718–25
     [Google Scholar]
  48. 48. 
    Rebuzzi AG, Natale A, Bianchi C et al. 1992. Importance of reperfusion on thromboxane A2 metabolite excretion after thrombolysis. Am. Heart J. 123:560–66
     [Google Scholar]
  49. 49. 
    Fitzgerald DJ, Wright F, FitzGerald GA 1989. Increased thromboxane biosynthesis during coronary thrombolysis. Evidence that platelet activation and thromboxane A2 modulate the response to tissue-type plasminogen activator in vivo. Circ. Res. 65:83–94
     [Google Scholar]
  50. 50. 
    ISIS-2 (Second International Study of Infarct Survival) Collab. Group 1988. Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. Lancet 2:349–60
     [Google Scholar]
  51. 51. 
    Fields WS, Lemak NA, Frankowski RF, Hardy RJ 1979. Controlled trial of aspirin in cerebral ischemia (AITIA study). Thromb. Haemost. 41:135–41
     [Google Scholar]
  52. 52. 
    Study Group UK-TIA 1988. United Kingdom transient ischaemic attack (UK-TIA) aspirin trial: interim results. BMJ Clin. Res. Ed 296:316–20
     [Google Scholar]
  53. 53. 
    Reuther R, Dorndorf W, Loew D 1980. Behandlung transitorisch-ischämischer Attacken mit Azetylsalizylsäure Ergebnisse einer Doppelblindstudie [The treatment of transitory ischemic attacks with acetylsalicylic acid: results of a double-blind-study (author's transl.)]. Munch. Med. Wochenschr. 122:795–98
     [Google Scholar]
  54. 54. 
    Canadian Cooperative Study Group 1978. A randomized trial of aspirin and sulfinpyrazone in threatened stroke. N. Engl. J. Med. 299:53–59
     [Google Scholar]
  55. 55. 
    Guiraud-Chaumeil B, Rascol A, David J et al. 1982. Prévention des récidives des accidents vasculaires cérébraux ischémiques par les anti-agrégants plaquettaires. Résultats d'un essai thérapeutique contrôlé de 3 ans [Prevention of recurrences of cerebral ischemic vascular accidents by platelet antiaggregants. Results of a 3-year controlled therapeutic trial]. Rev. Neurol. 138:367–85
     [Google Scholar]
  56. 56. 
    Bousser MG, Eschwege E, Haguenau M et al. 1983. “AICLA” controlled trial of aspirin and dipyridamole in the secondary prevention of athero-thrombotic cerebral ischemia. Stroke 14:5–14
     [Google Scholar]
  57. 57. 
    Sorensen PS, Pedersen H, Marquardsen J et al. 1983. Acetylsalicylic acid in the prevention of stroke in patients with reversible cerebral ischemic attacks. A Danish cooperative study. Stroke 14:15–22
     [Google Scholar]
  58. 58. 
    High-dose acetylsalicylic acid after cerebral infarction 1987. A Swedish Cooperative Study. Stroke 18:325–34
     [Google Scholar]
  59. 59. 
    Boysen G, Sørensen PS, Juhler M et al. 1988. Danish very-low-dose aspirin after carotid endarterectomy trial. Stroke 19:1211–15
     [Google Scholar]
  60. 60. 
    SALT Collab. Group 1991. Swedish Aspirin Low-Dose Trial (SALT) of 75 mg aspirin as secondary prophylaxis after cerebrovascular ischaemic events. Lancet 338:1345–49
     [Google Scholar]
  61. 61. 
    van Gijn J, Algra A, Kappelle J et al. 1991. A comparison of two doses of aspirin (30 mg versus 283 mg a day) in patients after a transient ischemic attack or minor ischemic stroke. N. Engl. J. Med. 325:1261–66
     [Google Scholar]
  62. 62. 
    Breddin K, Loew D, Lechner K et al. 1980. Secondary prevention of myocardial infarction: a comparison of acetylsalicylic acid, placebo and phenprocoumon. Haemostasis 9:325–44
     [Google Scholar]
  63. 63. 
    Antiplatelet Trialists’ Collab 1994. Collaborative overview of randomised trials of antiplatelet therapy—Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. BMJ Clin. Res. Ed 308:81–106
     [Google Scholar]
  64. 64. 
    Antithrombotic Trialists’ Collab 2002. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ Clin. Res. Ed. 324:71–86
     [Google Scholar]
  65. 65. 
    Smith SC Jr, Benjamin EJ, Bonow RO et al. 2011. AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation endorsed by the World Heart Federation and the Preventive Cardiovascular Nurses Association. J. Am. Coll. Cardiol. 58:2432–46
     [Google Scholar]
  66. 66. 
    Kernan WN, Ovbiagele B, Black HR et al. 2014. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 45:2160–236
     [Google Scholar]
  67. 67. 
    Piepoli MF, Hoes AW, Agewall S et al. 2016. 2016 European guidelines on cardiovascular disease prevention in clinical practice: the sixth joint task force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of 10 societies and by invited experts) developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur. Heart J. 37:2315–81
     [Google Scholar]
  68. 68. 
    Peto R, Gray R, Collins R et al. 1988. Randomised trial of prophylactic daily aspirin in British male doctors. BMJ Clin. Res. Ed. 296:313–16
     [Google Scholar]
  69. 69. 
    1989. Final report on the aspirin component of the ongoing Physicians’ Health Study. N. Engl. J. Med. 321:129–35
     [Google Scholar]
  70. 70. 
    Kassoff A, Buzney SM, McMeel JW et al. 1992. Aspirin effects on mortality and morbidity in patients with diabetes mellitus. Early Treatment Diabetic Retinopathy Study report 14. JAMA 268:1292–300
     [Google Scholar]
  71. 71. 
    Hansson L, Zanchetti A, Carruthers SG et al. 1998. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. Lancet 351:1755–62
     [Google Scholar]
  72. 72. 
    Belch J, MacCuish A, Campbell I et al. 2008. The prevention of progression of arterial disease and diabetes (POPADAD) trial: factorial randomised placebo controlled trial of aspirin and antioxidants in patients with diabetes and asymptomatic peripheral arterial disease. BMJ Clin. Res. Ed. 337:a1840
     [Google Scholar]
  73. 73. 
    Ogawa H, Nakayama M, Morimoto T et al. 2008. Low-dose aspirin for primary prevention of atherosclerotic events in patients with type 2 diabetes: a randomized controlled trial. JAMA 300:2134–41
     [Google Scholar]
  74. 74. 
    Goicoechea M, de Vinuesa SG, Quiroga B et al. 2018. Aspirin for primary prevention of cardiovascular disease and renal disease progression in chronic kidney disease patients: a multicenter randomized clinical trial (AASER Study). Cardiovasc. Drugs Ther. 32:255–63
     [Google Scholar]
  75. 75. 
    Fowkes FG, Price JF, Stewart MC et al. 2010. Aspirin for prevention of cardiovascular events in a general population screened for a low ankle brachial index: a randomized controlled trial. JAMA 303:841–48
     [Google Scholar]
  76. 76. 
    Medical Research Council's General Practice Research Framework 1998. Thrombosis prevention trial: randomised trial of low-intensity oral anticoagulation with warfarin and low-dose aspirin in the primary prevention of ischaemic heart disease in men at increased risk. Lancet 351:233–41
     [Google Scholar]
  77. 77. 
    de Gaetano GCollaborative Group of the Primary Prevention Project 2001. Low-dose aspirin and vitamin E in people at cardiovascular risk: a randomised trial in general practice. Lancet 357:89–95
     [Google Scholar]
  78. 78. 
    Ikeda Y, Shimada K, Teramoto T et al. 2014. Low-dose aspirin for primary prevention of cardiovascular events in Japanese patients 60 years or older with atherosclerotic risk factors: a randomized clinical trial. JAMA 312:2510–20
     [Google Scholar]
  79. 79. 
    Ridker PM, Cook NR, Lee IM et al. 2005. A randomized trial of low-dose aspirin in the primary prevention of cardiovascular disease in women. N. Engl. J. Med. 352:1293–304
     [Google Scholar]
  80. 80. 
    Li X, Fries S, Li R et al. 2014. Differential impairment of aspirin-dependent platelet cyclooxygenase acetylation by nonsteroidal antiinflammatory drugs. PNAS 111:16830–35
     [Google Scholar]
  81. 81. 
    Reilly IA, FitzGerald GA. 1987. Inhibition of thromboxane formation in vivo and ex vivo: implications for therapy with platelet inhibitory drugs. Blood 69:180–86
     [Google Scholar]
  82. 82. 
    Am. Diabetes Assoc 2019. 10. Cardiovascular disease and risk management. Standards of Medical Care in Diabetes—2019. Diabetes Care 42:S103–S123
     [Google Scholar]
  83. 83. 
    Arnett DK, Blumenthal RS, Albert MA et al. 2019. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J. Am. Coll. Cardiol. 74:1376–414
     [Google Scholar]
  84. 84. 
    Berger JS, Roncaglioni MC, Avanzini F et al. 2006. Aspirin for the primary prevention of cardiovascular events in women and men: a sex-specific meta-analysis of randomized controlled trials. JAMA 295:306–13
     [Google Scholar]
  85. 85. 
    Guirguis-Blake JM, Evans CV, Senger CA et al. 2016. Aspirin for the primary prevention of cardiovascular events: a systematic evidence review for the U.S. Preventive Services Task Force. Ann. Intern. Med. 164:804–13
     [Google Scholar]
  86. 86. 
    Whitlock EP, Burda BU, Williams SB et al. 2016. Bleeding risks with aspirin use for primary prevention in adults: a systematic review for the U.S. Preventive Services Task Force. Ann. Intern. Med. 164:826–35
     [Google Scholar]
  87. 87. 
    Mahmoud AN, Gad MM, Elgendy AY et al. 2019. Efficacy and safety of aspirin for primary prevention of cardiovascular events: a meta-analysis and trial sequential analysis of randomized controlled trials. Eur. Heart J. 40:607–17
     [Google Scholar]
  88. 88. 
    Zheng SL, Roddick AJ. 2019. Association of aspirin use for primary prevention with cardiovascular events and bleeding events: a systematic review and meta-analysis. JAMA 321:277–87
     [Google Scholar]
  89. 89. 
    Abdelaziz HK, Saad M, Pothineni NVK et al. 2019. Aspirin for primary prevention of cardiovascular events. J. Am. Coll. Cardiol. 73:2915–29
     [Google Scholar]
  90. 90. 
    Vandvik PO, Lincoff AM, Gore JM et al. 2012. Primary and secondary prevention of cardiovascular disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed.: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 141:e637S–e668S
     [Google Scholar]
  91. 91. 
    Perk J, De Backer G, Gohlke H et al. 2012. European guidelines on cardiovascular disease prevention in clinical practice (version 2012). The fifth joint task force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts). Eur. Heart J. 33:1635–701
     [Google Scholar]
  92. 92. 
    Bibbins-Domingo K. 2016. Aspirin use for the primary prevention of cardiovascular disease and colorectal cancer: U.S. Preventive Services Task Force recommendation statement. Ann. Intern. Med. 164:836–45
     [Google Scholar]
  93. 93. 
    Cosentino F, Grant PJ, Aboyans V et al. 2020. 2019 ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur. Heart J. 41:255–323
     [Google Scholar]
  94. 94. 
    Arnett DK, Blumenthal RS, Albert MA et al. 2019. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 140:e596–e646
     [Google Scholar]
  95. 95. 
    Halvorsen S, Andreotti F, ten Berg JM et al. 2014. Aspirin therapy in primary cardiovascular disease prevention: a position paper of the European Society of Cardiology working group on thrombosis. J. Am. Coll. Cardiol. 64:319–27
     [Google Scholar]
  96. 96. 
    Chiang KF, Shah SJ, Stafford RS 2019. A practical approach to low-dose aspirin for primary prevention. JAMA 322:4301–2
     [Google Scholar]
  97. 97. 
    Aimo A, De Caterina R 2019. Aspirin for primary cardiovascular prevention: Is there a need for risk stratification. Eur. Heart J. 40:2922–23
     [Google Scholar]
  98. 98. 
    Aimo A, De Caterina R 2020. Aspirin for primary cardiovascular prevention: Why the wonder drug should not be precipitously dismissed. Polish Arch. Intern. Med. 130:121–29
     [Google Scholar]
  99. 99. 
    Capodanno D, Angiolillo DJ. 2016. Aspirin for primary cardiovascular risk prevention and beyond in diabetes mellitus. Circulation 134:1579–94
     [Google Scholar]
  100. 100. 
    Moayyedi P, Eikelboom JW, Bosch J et al. 2019. Pantoprazole to prevent gastroduodenal events in patients receiving rivaroxaban and/or aspirin in a randomized, double-blind, placebo-controlled trial. Gastroenterology 157:403–12.e5
     [Google Scholar]
  101. 101. 
    Scally B, Emberson JR, Spata E et al. 2018. Effects of gastroprotectant drugs for the prevention and treatment of peptic ulcer disease and its complications: a meta-analysis of randomised trials. Lancet Gastroenterol. Hepatol. 3:231–41
     [Google Scholar]
  102. 102. 
    Li L, Geraghty OC, Mehta Z, Rothwell PM 2017. Age-specific risks, severity, time course, and outcome of bleeding on long-term antiplatelet treatment after vascular events: a population-based cohort study. Lancet 390:490–99
     [Google Scholar]
  103. 103. 
    Endo H, Sakai E, Taniguchi L et al. 2014. Risk factors for small-bowel mucosal breaks in chronic low-dose aspirin users: data from a prospective multicenter capsule endoscopy registry. Gastrointest. Endosc. 80:826–34
     [Google Scholar]
  104. 104. 
    Nagata N, Niikura R, Aoki T et al. 2015. Effect of proton-pump inhibitors on the risk of lower gastrointestinal bleeding associated with NSAIDs, aspirin, clopidogrel, and warfarin. J. Gastroenterol. 50:1079–86
     [Google Scholar]
  105. 105. 
    Yu EW, Bauer SR, Bain PA, Bauer DC 2011. Proton pump inhibitors and risk of fractures: a meta-analysis of 11 international studies. Am. J. Med. 124:519–26
     [Google Scholar]
  106. 106. 
    Janarthanan S, Ditah I, Adler DG, Ehrinpreis MN 2012. Clostridium difficile-associated diarrhea and proton pump inhibitor therapy: a meta-analysis. Am. J. Gastroenterol. 107:1001–10
     [Google Scholar]
  107. 107. 
    Rolnik DL, Wright D, Poon LC et al. 2017. Aspirin versus placebo in pregnancies at high risk for preterm preeclampsia. N. Engl. J. Med. 377:613–22
     [Google Scholar]
  108. 108. 
    Roberge S, Bujold E, Nicolaides KH 2018. Aspirin for the prevention of preterm and term preeclampsia: systematic review and metaanalysis. Am. J. Obstet. Gynecol. 218:287–93.e1
     [Google Scholar]
  109. 109. 
    Harris WH, Salzman EW, Athanasoulis CA et al. 1977. Aspirin prophylaxis of venous thromboembolism after total hip replacement. N. Engl. J. Med. 297:1246–49
     [Google Scholar]
  110. 110. 
    Cossetto DJ, Goudar A, Parkinson K 2012. Safety of peri-operative low-dose aspirin as a part of multimodal venous thromboembolic prophylaxis for total knee and hip arthroplasty. J. Orthop. Surg. 20:341–43
     [Google Scholar]
  111. 111. 
    Faour M, Piuzzi NS, Brigati DP et al. 2018. Low-dose aspirin is safe and effective for venous thromboembolism prophylaxis following total knee arthroplasty. J. Arthroplasty 33:S131–35
     [Google Scholar]
  112. 112. 
    Becattini C, Agnelli G, Schenone A et al. 2012. Aspirin for preventing the recurrence of venous thromboembolism. N. Engl. J. Med. 366:1959–67
     [Google Scholar]
  113. 113. 
    Veronese N, Stubbs B, Maggi S et al. 2017. Low-dose aspirin use and cognitive function in older age: a systematic review and meta-analysis. J. Am. Geriatr. Soc. 65:1763–68
     [Google Scholar]
  114. 114. 
    Matsumoto C, Ogawa H, Saito Y et al. 2020. Sex difference in effects of low-dose aspirin on prevention of dementia in patients with type 2 diabetes: a long-term follow-up study of a randomized clinical trial. Diabetes Care 43:314–20
     [Google Scholar]
  115. 115. 
    Ryan J, Storey E, Murray AM et al. 2020. Randomized placebo-controlled trial of the effects of aspirin on dementia and cognitive decline. Neurology 95:3e320–31
     [Google Scholar]
  116. 116. 
    Rothwell PM, Price JF, Fowkes FG et al. 2012. Short-term effects of daily aspirin on cancer incidence, mortality, and non-vascular death: analysis of the time course of risks and benefits in 51 randomised controlled trials. Lancet 379:1602–12
     [Google Scholar]
  117. 117. 
    Chan AT, Giovannucci EL, Meyerhardt JA et al. 2008. Aspirin dose and duration of use and risk of colorectal cancer in men. Gastroenterology 134:21–28
     [Google Scholar]
  118. 118. 
    Rothwell PM, Fowkes FG, Belch JF et al. 2011. Effect of daily aspirin on long-term risk of death due to cancer: analysis of individual patient data from randomised trials. Lancet 377:31–41
     [Google Scholar]
  119. 119. 
    Rothwell PM, Wilson M, Elwin CE et al. 2010. Long-term effect of aspirin on colorectal cancer incidence and mortality: 20-year follow-up of five randomised trials. Lancet 376:1741–50
     [Google Scholar]
  120. 120. 
    Bosetti C, Santucci C, Gallus S et al. 2020. Aspirin and the risk of colorectal and other digestive tract cancers: an updated meta-analysis through 2019. Ann. Oncol. 31:558–68
     [Google Scholar]
  121. 121. 
    Ye X, Fu J, Yang Y, Chen S 2013. Dose-risk and duration-risk relationships between aspirin and colorectal cancer: a meta-analysis of published cohort studies. PLOS ONE 8:e57578
     [Google Scholar]
  122. 122. 
    Burn J, Bishop DT, Chapman PD et al. 2011. A randomized placebo-controlled prevention trial of aspirin and/or resistant starch in young people with familial adenomatous polyposis. Cancer Prev. Res. 4:655–65
     [Google Scholar]
  123. 123. 
    Ishikawa H, Wakabayashi K, Suzuki S et al. 2013. Preventive effects of low-dose aspirin on colorectal adenoma growth in patients with familial adenomatous polyposis: double-blind, randomized clinical trial. Cancer Med 2:50–56
     [Google Scholar]
  124. 124. 
    Burn J, Bishop DT, Mecklin JP et al. 2008. Effect of aspirin or resistant starch on colorectal neoplasia in the Lynch syndrome. N. Engl. J. Med. 359:2567–78
     [Google Scholar]
  125. 125. 
    Burn J, Gerdes AM, Macrae F et al. 2011. Long-term effect of aspirin on cancer risk in carriers of hereditary colorectal cancer: an analysis from the CAPP2 randomised controlled trial. Lancet 378:2081–87
     [Google Scholar]
  126. 126. 
    Burn J, Sheth H, Elliott F et al. 2020. Cancer prevention with aspirin in hereditary colorectal cancer (Lynch syndrome), 10-year follow-up and registry-based 20-year data in the CAPP2 study: a double-blind, randomised, placebo-controlled trial. Lancet 395:1855–63
     [Google Scholar]
  127. 127. 
    Cook NR, Lee IM, Zhang SM et al. 2013. Alternate-day, low-dose aspirin and cancer risk: long-term observational follow-up of a randomized trial. Ann. Intern. Med. 159:77–85
     [Google Scholar]
  128. 128. 
    Chubak J, Whitlock EP, Williams SB et al. 2016. Aspirin for the prevention of cancer incidence and mortality: systematic evidence reviews for the U.S. Preventive Services Task Force. Ann. Intern. Med. 164:814–25
     [Google Scholar]
  129. 129. 
    Alfonso L, Ai G, Spitale RC, Bhat GJ 2014. Molecular targets of aspirin and cancer prevention. Br. J. Cancer 111:61–67
     [Google Scholar]
  130. 130. 
    Giardiello FM, Allen JI, Axilbund JE et al. 2014. Guidelines on genetic evaluation and management of Lynch syndrome: a consensus statement by the US Multi-Society Task Force on colorectal cancer. Gastroenterology 147:502–26
     [Google Scholar]
  131. 131. 
    Bromham N, Kallioinen M, Hoskin P, Davies RJ 2020. Colorectal cancer: summary of NICE guidance. BMJ Clin. Res. Ed. 368:m461
     [Google Scholar]
/content/journals/10.1146/annurev-med-051019-102940
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Aspirin in the Prevention of Cardiovascular Disease and Cancer
Annual Review of Medicine 72, 473 (2021); https://doi.org/10.1146/annurev-med-051019-102940
/content/journals/10.1146/annurev-med-051019-102940
/content/journals/10.1146/annurev-med-051019-102940
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