Aspirin May Be Ineffectual for Peripheral Vascular Disease

A new study suggests that aspirin has no significant effect on death rates from stroke, heart attack, or other major cardiac events in people suffering from peripheral vascular disease (PVD).

Researchers at the University of Florida and the Malcom Randall Veterans Affairs Medical Center conducted an electronic search of databases for all randomized trials comparing aspirin with either placebo or control in patients with PVD. The primary efficacy outcome was all-cause mortality, and the primary safety outcome was major bleeding. Other outcomes of interest were major adverse cardiac and cerebrovascular events (MACCE), myocardial infarction (MI), stroke, and intracranial hemorrhage.

In all, 6,560 patients from 11 trials were included in the study; the mean age was 62, 60% of the patients were women, 32% had diabetes, and 67% were current or ex-smokers. The results of the review showed that after six years, 7.7% of PVD patients who took aspirin had died, compared with 8.5% in the control group. The incidence of stroke was 3.2% among aspirin users and 4% among controls. Heart attacks were recorded in 3.5% of aspirin users and in 5.5% of non-users the prevalence of MACCE was also similar among both groups. The study was published on April 12, 2017, in PLOS One.

“Aspirin might not be a miracle drug for certain patients. We need to reconsider the evidence, and see who benefits from aspirin therapy and who does not,” said senior author Anthony Bavry, MD. “Patients who are on a daily aspirin regimen for cardiovascular issues should not stop taking the medicine on their own, but can consult their physician about whether the current findings may be relevant.”

The benefit of aspirin as secondary prevention therapy in patients with atherosclerosis has been clearly demonstrated in patients with prior ischemic stroke or acute myocardial infarction (MI). As a result, anti-platelet agents, particularly aspirin, have served as a cornerstone in therapeutic PVD management. But recent studies that failed to show a statistically significant reduction in vascular events have questioned the benefit of aspirin use in asymptomatic PVD patients with established atherosclerosis, but without evidence of an ischemic event.