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Epidemiological modelling of routine use of low dose aspirin for the primary prevention of coronary heart disease and stroke in those aged 70 years and above

journal contribution
posted on 2023-05-16, 16:55 authored by Mark NelsonMark Nelson, Liew, D, Bertram, M, Vos, T
Objective: To investigate the routine use of low dose aspirin in people aged ≥ 70 without overt cardiovascular disease. Design: Epidemiological modelling in a hypothetical population. Setting: Reference populations of men and women in the year 2000 from the state of Victoria, Australia. Subjects: 10 000 men and 10 000 women aged 70-74 with no cardiovascular disease. Main outcome measures: First ever myocardial infarction or unstable angina, ischaemic or haemorrhagic stroke, and major gastrointestinal haemorrhage. Health adjusted years of life lived. Results: The proportional benefit gained from the use of low dose aspirin by the prevention of myocardial infarctions ( - 389 in men, - 321 in women) and ischaemic stroke ( - 19 in men and - 35 in women) is offset by excess gastrointestinal (499 in men, 572 in women) and intracranial (76 in men, 54 in women) bleeding. The results in health adjusted years of life lived (which take into account length and quality of life) are equivocal for aspirin causing net harm or net benefit. Conclusion: Epidemiological modelling suggests that any benefits of low dose aspirin on risk of cardiovascular disease in people aged ≥ 70 are offset by adverse events. These findings are tempered by wide confidence intervals, indicating that the overall outcome could be beneficial or adverse.

History

Publication title

British Medical Journal

Volume

330

Issue

7503

Pagination

1306-1308

ISSN

0959-8146

Department/School

Tasmanian School of Medicine

Publisher

BMJ Publishing Group

Place of publication

London, England

Repository Status

  • Restricted

Socio-economic Objectives

Health related to ageing

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    University Of Tasmania

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