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Ann Intern Med. 2019 Sep 17. doi: 10.7326/M19-1132. [Epub ahead of print]

Personalized Prediction of Cardiovascular Benefits and Bleeding Harms From Aspirin for Primary Prevention: A Benefit-Harm Analysis.

Author information

1
University of Auckland, Auckland, New Zealand (V.S., R.J., K.P., B.W., M.H., C.G., R.P., S.M., Y.C., S.W.).
2
University of Auckland and Middlemore Hospital, Auckland, New Zealand (A.K.).

Abstract

Background:

Whether the benefits of aspirin for the primary prevention of cardiovascular disease (CVD) outweigh its bleeding harms in some patients is unclear.

Objective:

To identify persons without CVD for whom aspirin would probably result in a net benefit.

Design:

Individualized benefit-harm analysis based on sex-specific risk scores and estimates of the proportional effect of aspirin on CVD and major bleeding from a 2019 meta-analysis.

Setting:

New Zealand primary care.

Participants:

245 028 persons (43.6% women) aged 30 to 79 years without established CVD who had their CVD risk assessed between 2012 and 2016.

Measurements:

The net effect of aspirin was calculated for each participant by subtracting the number of CVD events likely to be prevented (CVD risk score × proportional effect of aspirin on CVD risk) from the number of major bleeds likely to be caused (major bleed risk score × proportional effect of aspirin on major bleeding risk) over 5 years.

Results:

2.5% of women and 12.1% of men were likely to have a net benefit from aspirin treatment for 5 years if 1 CVD event was assumed to be equivalent in severity to 1 major bleed, increasing to 21.4% of women and 40.7% of men if 1 CVD event was assumed to be equivalent to 2 major bleeds. Net benefit subgroups had higher baseline CVD risk, higher levels of most established CVD risk factors, and lower levels of bleeding-specific risk factors than net harm subgroups.

Limitations:

Risk scores and effect estimates were uncertain. Effects of aspirin on cancer outcomes were not considered. Applicability to non-New Zealand populations was not assessed.

Conclusion:

For some persons without CVD, aspirin is likely to result in net benefit.

Primary Funding Source:

Health Research Council of New Zealand.

PMID:
31525775
DOI:
10.7326/M19-1132

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