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Clinical Guidelines—Aspirin Use for the Prevention of Cardiovascular Disease
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Heart Disease and StrokeBackground
Heart disease and stroke are two of the leading causes of death in the United States.
Americans suffer more than 2 million heart attacks
and strokes each year.
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Heart Disease and StrokeRisk Factors
Approximately 49% of adults have at least one major risk factor for heart disease and stroke.
(Source: www.cdc.gov/heartdisease/facts.htm 3/23/12)
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Heart Disease and StrokeMortality Rates by Ethnicity
(Source: http://www.cdc.gov/heartdisease/facts.htm 3/23/12)
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Aspirin TherapyBenefits
The U.S. Preventive Services Task Force (USPSTF) found good evidence that aspirin decreases the incidence of myocardial infarction in men and ischemic strokes in women.
However…the USPSTF also found good evidence that aspirin increases the incidence of gastrointestinal bleeding and fair evidence that aspirin increases the incidence of hemorrhagic stroke.
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Aspirin TherapyBenefits
The benefits of aspirin therapy depend substantially on an individual’s risk of cardiovascular disease or stroke and adverse treatment effects.
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Aspirin TherapyBenefits
Understanding who benefits from aspirin use, and how much, can help clinicians and patients develop a more patient-centered approach to preventive therapy.
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Aspirin TherapyClinical Guidelines
The USPSTF recommends aspirin therapy for
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Aspirin TherapyClinical Guidelines
According to the USPSTF,
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Aspirin TherapyRisk of GI Bleeding
Age: Increases with age—with or without aspirin therapy
Gender: Twice the risk for men
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Aspirin TherapyRisk of GI Bleeding
GI Ulcers: 2 to 3 times greater in patients with history of GI ulcers
Non-SteroidalAnti-inflammatoryDrug (NSAID) Use:
Quadruples risk for serious GI bleeding compared to aspirin use alone
Other Factors: History or presence of upper GI tract pain, uncontrolled hypertension, and concomitant use of anticoagulants
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Aspirin Therapy - MenBenefit vs Risk
The net benefit of aspirintherapy for men depends on
• the initial risk for coronary heart disease (CHD) events and
• GI bleeding.
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Aspirin Therapy - MenRisk Factors for CHD
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Aspirin Therapy - MenRisk Factors for CHD
Tools to determine individual risk for CHD
National Cholesterol Education Program
Million Hearts
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Aspirin Therapy - WomenBenefit vs Risk
The net benefit of aspirintherapy for womendepends on• the initial risk for stroke and• GI bleeding.
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WomenRisk Factors for Stroke
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Aspirin Therapy - WomenRisk Factors for Stroke
Tools to determine individual risk for stroke
Personal StrokeRisk
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Aspirin TherapyWeighing Benefits
Ultimately, aspirin therapy is the patient’s choice.
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Aspirin TherapyWeighing Benefits
Estimated heart attacksprevented and estimatedharms of using aspirin for10 years in a hypotheticalcohort of 1000 men aged45-79 years.
(Source: http://www.uspreventiveservicetaskforce.org/uspstf09/aspirincvd.aspcvdrsf2.htm)
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Aspirin TherapyWeighing Benefits
(Source: http://www.uspreventiveservicestaskforce.org/uspstf09/aspirincvd/aspcvdrsf4.htm)
Estimated number ofstrokes preventedaccording to the strokerisk level in women aged45 to 79 years.
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Aspirin TherapyWeighing Benefits
Those with a high likelihood of benefiting with little potential for harm should be encouraged to consider aspirin.
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Aspirin TherapyWeighing Benefits
Aspirin should be discouraged
among those with little potential of benefiting or ahigh risk of GI bleeding.
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Aspirin TherapyWeighing Benefits
Some might decide thatavoiding a heart attack orstroke is of greater value thanhaving GI bleeding.
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Aspirin TherapyWeighing Benefits
Encourage shared decision-making with those whose potential benefits and risks for serious GI bleeding are more closely balanced.
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Aspirin TherapyDose/Dosage
According to USPSTF• The optimum dose of aspirin for preventing
cardiovascular disease events and stroke is unknown.
• Primary prevention trials have shown benefits with various regimens.
• Approximately 75 mg/d aspirin seems as effective as higher dosages.
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Remember
Understanding who benefits from aspirin use, and how much, can help clinicians and patients develop a more patient-centered approach to preventive therapy.
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Resources
U.S. Preventative Services Task Force (USPSTF)Aspirin for the Prevention of Cardiovascular Disease
Centers for Disease ControlRecommendations for Aspirin for Prevention of Cardiovascular Disease
Million Hearts
PubMed.gov Individual and Population Benefits of Daily Aspirin Therapy: a Proposal for Personalizing National Guidelines
