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Aspirin for Asymptomatic Carotid Artery Stenosis
- Robert G. Hart, MD; and
- Diane H. Solomon, MD
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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.
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
