{"id":"182803fc72da","type":"article","url":"https://hartvaat.nl/2019/01/22/aspirine-voor-primaire-preventie-jama-meta-analyse-van-cv-events-en-bloedingen/","title":"Aspirine voor primaire preventie: JAMA meta-analyse van CV-events en bloedingen","title_en":"Association of Aspirin Use for Primary Prevention With Cardiovascular Events and Bleeding Events: A Systematic Review and Meta-analysis.","category":"preventie","category_label":"Preventie","professions":["cardioloog","huisarts","internist"],"tags":["aspirine","primaire-preventie"],"journal":"JAMA","doi":"10.1001/jama.2018.20578","source_url":"https://doi.org/10.1001/jama.2018.20578","authors":["Sean L Zheng","Alistair J Roddick"],"significance":9,"published":"2019-01-22","source_date":"2019-01-22","image":"","kennis":["https://hartvaat.nl/kennis/preventie/aspirine-primaire-preventie/"],"congress":"","summary_en":"This JAMA meta-analysis of aspirin for primary cardiovascular prevention showed a modest reduction in cardiovascular events offset by increased major bleeding, particularly gastrointestinal and intracranial hemorrhage. The findings informed the paradigm shift against routine aspirin use in primary prevention.","created":"2026-07-03T10:27:44Z","updated":"2026-07-03T13:26:57Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA meta-analyse die aspirine voor primaire preventie samenvat: bescheiden voordeel op CV-events overschaduwd door bloedingsrisico. Keerpunt in het aspirine-debat.","abstract_original":"IMPORTANCE: The role for aspirin in cardiovascular primary prevention remains controversial, with potential benefits limited by an increased bleeding risk. OBJECTIVE: To assess the association of aspirin use for primary prevention with cardiovascular events and bleeding. DATA SOURCES: PubMed and Embase were searched on Cochrane Library Central Register of Controlled Trials from the earliest available date through November 1, 2018. STUDY SELECTION: Randomized clinical trials enrolling at least 1000 participants with no known cardiovascular disease and a follow-up of at least 12 months were included. Included studies compared aspirin use with no aspirin (placebo or no treatment). DATA EXTRACTION AND SYNTHESIS: Data were screened and extracted independently by both investigators. Bayesian and frequentist meta-analyses were performed. MAIN OUTCOMES AND MEASURES: The primary cardiovascular outcome was a composite of cardiovascular mortality, nonfatal myocardial infarction, and nonfatal stroke. The primary bleeding outcome was any major bleeding (defined by the individual studies). RESULTS: A total of 13 trials randomizing 164 225 participants with 1 050 511 participant-years of follow-up were included. The median age of trial participants was 62 years (range, 53-74), 77 501 (47%) were men, 30 361 (19%) had diabetes, and the median baseline risk of the primary cardiovascular outcome was 9.2% (range, 2.6%-15.9%). Aspirin use was associated with significant reductions in the composite cardiovascular outcome compared with no aspirin (57.1 per 10 000 participant-years with aspirin and 61.4 per 10 000 participant-years with no aspirin) (hazard ratio [HR], 0.89 [95% credible interval, 0.84-0.95]; absolute risk reduction, 0.38% [95% CI, 0.20%-0.55%]; number needed to treat, 265). Aspirin use was associated with an increased risk of major bleeding events compared with no aspirin (23.1 per 10 000 participant-years with aspirin and 16.4 per 10 000 participant-years with no aspirin) (HR, 1.43 [95% credible interval, 1.30-1.56]; absolute risk increase, 0.47% [95% CI, 0.34%-0.62%]; number needed to harm, 210). CONCLUSIONS AND RELEVANCE: The use of aspirin in individuals without cardiovascular disease was associated with a lower risk of cardiovascular events and an increased risk of major bleeding. This information may inform discussions with patients about aspirin for primary prevention of cardiovascular events and bleeding."}