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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\u003Cp id=\u0022p-1\u0022\u003EThe use of aspirin as a preventative for cardiovascular disease (CVD) is controversial. This article reviews data from the Japanese Primary Prevention Project study [JPPP], which investigated whether a daily, low-dose aspirin would reduce the risk of CVD in elderly Japanese patients with risk factors for atherosclerosis.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Ecoronary artery disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecardiology clinical trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\u003Cp id=\u0022p-2\u0022\u003EKazuyuki Shimada, University of Shin-Oyama City Hospital, Tochigi, Japan, presented data from the Japanese Primary Prevention Project study [JPPP; Ikeda Y et al. \u003Cem\u003EJAMA.\u003C\/em\u003E 2014], which found that daily, low-dose aspirin did not reduce the risk of cardiovascular disease (CVD) in elderly Japanese patients with risk factors for atherosclerosis.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EThe use of aspirin as a preventative for CVD is controversial. Although meta-analyses have reported benefits of aspirin for CVD prevention, risks have also been documented [Raju NC, Eikelboom JW. \u003Cem\u003ECurr Opin Cardiol.\u003C\/em\u003E 2012]. In addition, the US Food and Drug Administration (FDA) recently stated that current evidence does not support the general use of aspirin for the prevention of CVD [FDA. Use of Aspirin for Primary Prevention of Heart Attack and Stroke. 2014]. The purpose of the JPPP trial was to evaluate if the daily use of low-dose aspirin was effective in reducing the risk of cardiovascular (CV) events in an elderly Japanese population with risk factors for atherosclerosis.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EIn the prospective, randomized, open-blinded trial, 14 658 Japanese patients aged 60 to 85 years with hypertension, dyslipidemia, or diabetes mellitus were randomly assigned in a 1:1 fashion to receive enteric-coated aspirin 100 mg\/d or no aspirin, in addition to their current medication to control underlying disease(s). The median follow-up was 5.02 years. At baseline, the mean age was about 71 years, about 42% were men, the mean body mass index was 24 kg\/m\u003Csup\u003E2\u003C\/sup\u003E, and approximately 13% of the patients were current smokers.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EThe primary end point was a composite of death from CV causes, nonfatal stroke, and nonfatal myocardial infarction (MI). Secondary end points included a composite of the primary end point plus transient ischemic attack, angina pectoris, and arteriosclerotic disease that required intervention. Secondary end points also included individual end points that made up the composite end points and death from causes other than CV events, all-cause mortality, and serious extracranial hemorrhage.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EThere was no significant difference in the proportion of patients who experienced the primary end point among the aspirin and no-aspirin arms at year 6 (2.77% with aspirin vs 2.96 with placebo; HR, 0.94; 95% CI, 0.77 to 1.15; \u003Cem\u003EP\u003C\/em\u003E = .54). The results were consistent among major subgroups. Several secondary efficacy end points reached appeared to be lower with aspirin, including nonfatal MI (HR, 0.53; 95% CI, 0.31 to 0.91; \u003Cem\u003EP\u003C\/em\u003E = .02) and transient ischemic attacks (HR, 0.57; 95% CI, 0.32 to 0.99; \u003Cem\u003EP\u003C\/em\u003E =.04).\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EAspirin treatment resulted in a significantly greater rate of serious extracranial hemorrhage (HR, 1.85; 95% CI, 1.22 to 2.81; \u003Cem\u003EP\u003C\/em\u003E = .004). In addition, patients who received aspirin were more likely to experience abdominal discomfort, gastroduodenal ulcer, abdominal pain, heartburn, reflux esophagitis, erosive gastritis, gastrointestinal hemorrhage, and nausea.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EProf Shimada concluded that the data from the JPPP trial suggest that daily low-dose aspirin is not effective in decreasing the risk of CVD in elderly Japanese patients. However, he pointed out that the study was terminated early before statistical power was reached, which may have attributed to the observed lack of benefit for the primary end point.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/52\/15.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzocrp\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}