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  • Question on Consultation

    Do you agree with the proposal to update cardiovascular disease: risk assessment and reduction, including lipid modification (NICE guideline CG181) to add a ‘do not offer’ recommendation about aspirin for the primary prevention of cardiovascular disease?Please give a rationale for your decision. (Information about when to make a ‘do not offer’ recommendation can be found in NICE guidelines: the manual section 9.1 Interpreting the evidence to make recommendations).

  • Question on Consultation

    Are you aware of any issues related to inequalities for specific subgroups of the population?Please provide details on any issues.
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2022 surveillance of cardiovascular disease: risk assessment and reduction, including lipid modification (NICE guideline CG181) focussing on the role of aspirin for the primary prevention of cardiovascular disease

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Surveillance proposal

We will update the guideline on cardiovascular disease: risk assessment and reduction, including lipid modification to add a 'do not offer' recommendation about the use of aspirin for the primary prevention of cardiovascular disease (CVD).

Trigger for this exceptional surveillance review

Members of NICE's CVD committee highlighted to us that there is new evidence for aspirin for the primary prevention of CVD from the ASCEND, ASPREE, and ARRIVE studies. These are large trials investigating the efficacy of aspirin in various populations considered to be at risk of CVD.

Rationale for the surveillance proposal

ASCEND, ARRIVE and ASPREE report that while the use of aspirin for primary prevention of cardiovascular disease does reduce the rate of cardiovascular events, the benefit is largely offset by the risks from increased rates of bleeding. This finding is reported consistently by other studies we identified during this surveillance review. While some studies suggest an increased benefit for specific cardiovascular events, e.g., stroke and myocardial infarction (MI), compared with composite cardiovascular outcomes, and for specific subgroups, e.g., those at low long-term risk, non-smokers or those taking statins, this increased benefit is unlikely to outweigh the risks posed by bleeding. We identified limited evidence for net benefit in some subgroups, but it is largely from modelling studies which are not enough to base recommendations on because of their level of uncertainty.

For further details and a summary of key evidence identified in surveillance, see the summary of evidence from surveillance.