Key result
Modeled low-dose aspirin reduces fatal CVD and CRC more than it increases fatal safety events.
Why the study?
Low-dose aspirin reduces cardiovascular disease risk and may prevent colorectal cancer, but its population-level balance of CVD, CRC, and bleeding effects required evaluation.
Does regular low-dose aspirin use reduce cardiovascular disease and colorectal cancer in populations aged 50-69 indicated for CVD prevention?
Does regular low-dose aspirin use reduce cardiovascular disease and colorectal cancer in populations aged 50-69 indicated for CVD prevention?
A microsimulation model suggests the reduction in fatal CVD and CRC events with low-dose aspirin outweighs the increase in fatal safety events, with greater net benefit in secondary prevention.
May support net benefit in secondary prevention; leaves open translation to primary prevention without prospective trials.
BACKGROUND: Low-dose aspirin therapy reduces the risk of cardiovascular disease and may have a positive effect on the prevention of colorectal cancer. We evaluated the population-level expected effect of regular low-dose aspirin use on cardiovascular disease (CVD), colorectal cancer (CRC), gastrointestinal bleeding, symptomatic peptic ulcers, and intracranial hemorrhage, using a microsimulation study design. METHODS: We used individual-level state transition modeling to assess the impact of aspirin in populations aged 50-59 or 60-69 years old indicated for low-dose aspirin usage for primary or secondary CVD prevention. Model parameters were based on data from governmental agencies from the UK or recent publications. RESULTS: In the 50-59 years cohort, a decrease in incidence rates (IRs per 100 000 person years) of non-fatal CVD (-203 and -794) and fatal CVD (-97 and-381) was reported in the primary and secondary CVD prevention setting, respectively. The IR reduction of CRC (-96 and -93) was similar for primary and secondary CVD prevention. The IR increase of non-fatal (116 and 119) and fatal safety events (6 and 6) was similar for primary and secondary CVD prevention. Similar results were obtained for the 60-69 years cohort. CONCLUSIONS: The decrease in fatal CVD and CRC events was larger than the increase in fatal safety events and this difference was more pronounced when low-dose aspirin was used for secondary compared to primary CVD prevention. These results provide a comprehensive image of the expected effect of regular low-dose aspirin therapy in a UK population indicated to use aspirin for CVD prevention.
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Biccler et al. (2021) studied Cardiovascular disease prevention. Low-dose aspirin was evaluated on Incidence rates of cardiovascular disease, colorectal cancer, and safety events. In a UK microsimulation model, low-dose aspirin decreased incidence rates of fatal CVD and colorectal cancer more than it increased fatal safety events, particularly for secondary prevention.
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