LETTER
Aspirin for Asymptomatic Carotid Artery Stenosis
Robert G. Hart, MD, and
Diane H. Solomon, MD
1 September 1996 | Volume 125 Issue 5 | Page 420
TO THE EDITOR:
Cote and colleagues [1] did not cite the relevant results of a randomized trial from the Mayo Clinic [2] that involved patients with asymptomatic carotid stenosis and was stopped prematurely because of reduced myocardial infarction (P < 0.01) in patients given aspirin, 80 mg/d, compared with those who had carotid endarterectomy and received no aspirin (most myocardial infarctions were unrelated to surgery). Presumably, many of the 533 patients who did not participate in this study because of a medical requirement for aspirin had manifest coronary artery disease. This condition may have contributed to the unusual predominance of female participants.
Because of low event rates, the Mayo Clinic study did not accrue enough events (particularly myocardial infarctions) to exclude a clinically important benefit of aspirin within the range predicted from several other clinical trials [3, 4]. Given 1) the substantial threat of myocardial infarction and vascular death for most patients with asymptomatic carotid stenosis, 2) the unequivocal efficacy of low-dose aspirin for preventing myocardial infarction [3, 4], and 3) the wide CI in the effect of aspirin on myocardial infarction in the study by Cote and colleagues, low-dose aspirin in most patients with asymptomatic carotid stenosis seems to be a sensible way to prevent myocardial infarction.
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Author and Article Information
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University of Texas Health Sciences Center, San Antonio, TX 78217
1. Cote R, Battista RN, Abrahamowicz M, Langlois Y, Bourque F, Mackey A, et al. Lack of effect of aspirin in asymptomatic patients with carotid bruits and substantial carotid narrowing. Ann Intern Med. 1995; 123:649-55.
2. Results of a randomized controlled trial of carotid endarterectomy for asymptomatic carotid stenosis. Mayo Clinic Asymptomatic Carotid Endarterectomy Study Group. Mayo Clin Proc. 1992; 67:513-8.
3. Collaborative overview of randomized trials of antiplatelet therapy. Antiplatelet Trialists Collaboration. BMJ. 1994; 308:81-106.
4. Final report on the aspirin component of the ongoing Physician Health Study. Steering Committee of the Physician Health Study Research Group. N Engl J Med. 1991; 325:445-53.
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