Aspirin for primary prevention was likely to provide a net benefit over 5 years for 2.5% of women and 12.1% of men when assuming 1 CVD event equals 1 major bleed.
Observational (n=245,028)
Does aspirin improve net clinical benefit (CVD prevention versus bleeding harms) in persons without established CVD?
A personalized benefit-harm analysis suggests that a specific subset of patients without established CVD (particularly men and those with high CVD risk but low bleeding risk) may derive net clinical benefit from prophylactic aspirin.
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.
Selak et al. (Mon,) conducted a observational in Without established cardiovascular disease (n=245,028). Aspirin was evaluated on Net effect of aspirin (CVD events prevented minus major bleeds caused). Aspirin for primary prevention was likely to provide a net benefit over 5 years for 2.5% of women and 12.1% of men when assuming 1 CVD event equals 1 major bleed.
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