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December 1990

Aspirin and the Primary Prevention of Myocardial Infarction and Stroke

Arch Neurol. 1990;47(12):1354. doi:10.1001/archneur.1990.00530120100019

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We measure what we can, not necessarily what is most important. As Jonas demonstrates with persuasive clarity, quality of life and its loss may be more appropriate measures of outcome than conventional assessments of morbidity and mortality. Jonas concludes that, by his indexes, the possible benefits of aspirin in primary prevention remain unproven, and worries about the possible increased risk of stroke of individuals receiving aspirin. The latter is not only unproven, but unlikely.

The physicians reported to have suffered hemorrhagic strokes were few, younger than the usual age for stroke, and never had their diagnosis confirmed by computed tomography of the brain. Moreover, the experience with large studies with aspirin in prevention of myocardial infarction and stroke fail to identify an increased risk for stroke of any type.

Buring and colleagues acknowledge that uncertainties remain about the indications of aspirin in primary prevention, but invoke the evidence of aspirin's

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