No aspirin for primary prevention

The most consistent concept in medicine involves change.  Our data changes; our beliefs change; our understanding of disease changes.  Once again we have change.

Aspirin Fails Again for Primary Prevention

Aspirin makes sense for primary prevention, but we know that ideas that make sense do not always work in medicine.  The data against aspirin for primary prevention are now overwhelming.

This should come as little surprise, commented William R. Hiatt, M.D., of the University of Colorado in Denver, in an accompanying editorial.

Six other well-controlled trials, including the Women’s Health Study and Physicians’ Health Study, have shown no benefit for aspirin in primary prevention even for at-risk patients despite the well-established benefits in secondary prevention, he said.

"The mechanisms of this differential response to aspirin are not known," he wrote, "but clearly suggest that patients who respond to aspirin must have a history of clinical, symptomatic cardiovascular disease."

I am changing my teaching and my practice.  I am convinced.