{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:35:54Z","timestamp":1787016954158,"version":"build-2736575974"},"reference-count":25,"publisher":"BMJ","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Heart"],"accepted":{"date-parts":[[2000,9,14]]},"published-print":{"date-parts":[[2001,3,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>To determine the cardiovascular and coronary risk thresholds at which aspirin for primary prevention of coronary heart disease is safe and worthwhile.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>DESIGN<\/jats:title>\n                    <jats:p>Meta-analysis of four randomised controlled trials of aspirin for primary prevention. The benefit and harm from aspirin treatment were examined to determine: (1) the cardiovascular and coronary risk threshold at which benefit in prevention of myocardial infarction exceeds harm from significant bleeding; and (2) the absolute benefit expressed as number needed to treat (NNT) for aspirin net of cerebral haemorrhage and other bleeding complications at different levels of coronary risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>MAIN OUTCOME MEASURES<\/jats:title>\n                    <jats:p>Benefit from aspirin, expressed as reduction in cardiovascular events, myocardial infarctions, strokes, and total mortality; harm caused by aspirin in relation to significant bleeds and major haemorrhages.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Aspirin for primary prevention significantly reduced all cardiovascular events by 15% (95% confidence interval (CI) 6% to 22%) and myocardial infarctions by 30% (95% CI 21% to 38%), and non-significantly reduced all deaths by 6% (95% CI \u22124% to 15%). Aspirin non-significantly increased strokes by 6% (95% CI \u221224% to 9%) and significantly increased bleeding complications by 69% (95% CI 38% to 107%). The risk of major bleeding balanced the reduction in cardiovascular events when cardiovascular event risk was 0.22%\/year. The upper 95% CI for this estimate suggests that harm from aspirin is unlikely to outweigh benefit provided the cardiovascular event risk is 0.8%\/year, equivalent to a coronary risk of 0.6%\/year. At coronary event risk 1.5%\/year, the five year NNT was 44 to prevent a myocardial infarction, and 77 to prevent a myocardial infarction net of any important bleeding complication. At coronary event risk 1%\/year the NNT was 67 to prevent a myocardial infarction, and 182 to prevent a myocardial infarction net of important bleeding.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Aspirin treatment for primary prevention is safe and worthwhile at coronary event risk \u2a7e\u20091.5%\/year; safe but of limited value at coronary risk 1%\/year; and unsafe at coronary event risk 0.5%\/year. Advice on aspirin for primary prevention requires formal accurate estimation of absolute coronary event risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/heart.85.3.265","type":"journal-article","created":{"date-parts":[[2002,7,27]],"date-time":"2002-07-27T06:37:59Z","timestamp":1027751879000},"page":"265-271","source":"Crossref","is-referenced-by-count":290,"title":["Aspirin for primary prevention of coronary heart disease: safety and absolute benefit related to coronary risk derived from meta-analysis of randomised trials"],"prefix":"10.1136","volume":"85","author":[{"given":"P S","family":"Sanmuganathan","sequence":"first","affiliation":[{"name":"Clinical Pharmacology and Therapeutics, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P","family":"Ghahramani","sequence":"additional","affiliation":[{"name":"Clinical Pharmacology and Therapeutics, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P R","family":"Jackson","sequence":"additional","affiliation":[{"name":"Clinical Pharmacology and Therapeutics, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E J","family":"Wallis","sequence":"additional","affiliation":[{"name":"Clinical Pharmacology and Therapeutics, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L E","family":"Ramsay","sequence":"additional","affiliation":[{"name":"Clinical Pharmacology and Therapeutics, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2001,3,1]]},"reference":[{"key":"2025101721433439000_85.3.265.1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.308.6921.81"},{"key":"2025101721433439000_85.3.265.2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.280.22.1930"},{"key":"2025101721433439000_85.3.265.3","doi-asserted-by":"publisher","DOI":"10.1001\/jama.280.22.1949"},{"key":"2025101721433439000_85.3.265.4","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198907203210301"},{"key":"2025101721433439000_85.3.265.5","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(97)11475-1"},{"key":"2025101721433439000_85.3.265.6","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(98)04311-6"},{"key":"2025101721433439000_85.3.265.7","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.96.8.2751"},{"key":"2025101721433439000_85.3.265.8","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.310.6983.827"},{"key":"2025101721433439000_85.3.265.9","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(96)01254-8"},{"key":"2025101721433439000_85.3.265.10","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1136\/bmj.296.6618.313","article-title":"Randomised trial of prophylactic daily aspirin in British male doctors.","volume":"296","author":"Peto","year":"1988","journal-title":"BMJ"},{"key":"2025101721433439000_85.3.265.11","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1016\/S0140-6736(05)76185-7","article-title":"Risk of major gastrointestinal bleeding with aspirin.","volume":"353","author":"Isles","year":"1999","journal-title":"Lancet"},{"key":"2025101721433439000_85.3.265.12","unstructured":"Armitage P Berry G (1994) Statistical methods in medical research (Blackwell, Oxford), 3rd ed. pp 215\u2013219, , 169\u201371."},{"key":"2025101721433439000_85.3.265.13","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/0197-2456(89)90054-8","article-title":"Large trials with simple protocols: indications and contraindications.","volume":"10","author":"Lubsen","year":"1989","journal-title":"Control Clin Trials"},{"key":"2025101721433439000_85.3.265.14","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.317.7168.1309"},{"key":"2025101721433439000_85.3.265.15","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.320.7236.671"},{"key":"2025101721433439000_85.3.265.16","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.321.7252.13"},{"key":"2025101721433439000_85.3.265.17","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1097\/00004872-200018050-00017","article-title":"Influence of gender and age on preventing cardiovascular disease by antihypertensive treatment and acetylsalicylic acid. 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