Evaluation of the Benefits and Risks of Low-Dose Aspirin in the Secondary Prevention of Cardiovascular and Cerebrovascular Events

Abstract

SINCE ITS introduction in 1899, aspirin has been recognized as a drug with a favorable benefit-to-risk ratio. Ironically, aspirin was advertised in the 1920s with the claim that it did not affect the heart, unlike other drugs of the time, which were thought to have an "enfeebling" effect. More than 100 years after its introduction, it is now clear that aspirin can positively affect the heart, especially in the management of acute evolving myocardial infarction. Data from numerous controlled clinical trials provided the basis for its approval by the US Food and Drug Administration (FDA) for use in prevention of thromboembolic events in individuals who had a previous myocardial infarction, transient ischemic attack (TIA), or stroke. In spite of the clear evidence of benefit of aspirin in the secondary prevention of vascular events, its use in patients at high risk due to a previous event remains suboptimal.¹ One possible explanation for underuse of aspirin by physicians is concern regarding the potential for serious adverse effects on the gastrointestinal tract (GI).