+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Are the benefits of aspirin likely to exceed the risk of major bleeds among people in whom aspirin is recommended for the primary prevention of cardiovascular disease?



Are the benefits of aspirin likely to exceed the risk of major bleeds among people in whom aspirin is recommended for the primary prevention of cardiovascular disease?



New Zealand Medical Journal 131(1484): 19-25



The 2018 New Zealand Consensus Statement on cardiovascular disease (CVD) risk assessment and management recommends the use of aspirin in people aged less than 70 years with a five-year CVD risk >15% but without prior CVD. We determined whether the estimated number of CVD events avoided by taking aspirin is likely to exceed the number of additional major bleeds caused by aspirin in this patient population. Major bleeding rates were obtained from the PREDICT primary care study, a large New Zealand cohort of people eligible for CVD risk assessment, after excluding those with no other indications for (eg, established CVD) or contraindications/cautions (eg, prior major bleed) to aspirin use. We modelled the benefits (CVD events avoided) and harms (additional major bleeds) of aspirin for primary prevention of CVD over five years using hypothetical populations aged 40 to 79 years, stratified by sex, age-group and estimated five-year CVD risk. Two clinical scenarios were modelled, according to whether or not optimisation of lipid- and blood pressure-lowering therapy was required prior to aspirin initiation. In both clinical scenarios the number of CVD events prevented by aspirin over five years was estimated to be, on average, more than the number of bleeds caused by aspirin among people aged less than 70 years with estimated five-year CVD risk of >15%. However, the magnitude of the net benefit of aspirin was modest among people aged 60-69 years, particularly if lipid- and blood pressure-lowering therapy had not already been optimised. The benefits of aspirin are likely to exceed the risk of major bleeds among people in whom aspirin is recommended for the primary prevention of CVD. A more cautious approach to the use of aspirin is appropriate for people aged 60-69 years who are likely to have a smaller net benefit from aspirin, particularly those in whom lipid- and blood pressure-lowering therapy has not already been optimised or who have other bleeding risk factors, such as diabetes or smoking. More specific recommendations will be possible when bleeding risk equations are developed to complement the recently developed New Zealand CVD risk equations.

Please choose payment method:






(PDF emailed within 1 workday: $29.90)

Accession: 065699533

Download citation: RISBibTeXText

PMID: 30359352


Related references

An aspirin a day? Aspirin use across a spectrum of risk: cardiovascular disease, cancers and bleeds. Expert Opinion on PharmacoTherapy 15(2): 153-157, 2014

Feasibility of conducting a primary prevention trial of low-dose aspirin for major adverse cardiovascular events in older people in Australia: results from the ASPirin in Reducing Events in the Elderly (ASPREE) pilot study. Medical Journal of Australia 189(2): 105-109, 2008

Which people should take aspirin for primary prevention of cardiovascular disease?. Therapeutics and Clinical Risk Management 11: 1043-1045, 2015

Should aspirin be used for the primary prevention of cardiovascular disease in people with diabetes?. Medical Journal of Australia 190(11): 614-615, 2009

Aspirin and omeprazole for secondary prevention of cardiovascular disease in patients at risk for aspirin-associated gastric ulcers. Expert Review of Clinical Pharmacology 10(8): 875-888, 2017

Low-dose aspirin in the primary prevention of cardiovascular disease: how to balance the benefits and the risks. Italian Heart Journal 4(4): 228-231, 2003

Harms and Benefits of Using Aspirin for Primary Prevention of Cardiovascular Disease: A Narrative Overview. Seminars in Thrombosis and Hemostasis 2018, 2018

The Effects of Different Aspirin Dosing Frequencies and the Timing of Aspirin Intake in Primary and Secondary Prevention of Cardiovascular Disease: A Systematic Review. Clinical Pharmacology and Therapeutics 100(5): 500-512, 2016

Laboratory aspirin resistance and the risk of major adverse cardiovascular events in patients with coronary heart disease on confirmed aspirin adherence. Journal of Atherosclerosis and Thrombosis 21(3): 239-247, 2014

Tighter aspirin control urged for patients with diabetes. Taking aspirin increases bleeding risk that is not always outweighed by the potential benefits for patients with low cardiovascular disease risk. Heart Advisor 13(8): 6-6, 2012

Investigating the effectiveness of different aspirin dosing regimens and the timing of aspirin intake in primary and secondary prevention of cardiovascular disease: protocol for a systematic review. Systematic Reviews 4: 88, 2016

Rivaroxaban plus aspirin, compared with aspirin alone, reduced cardiovascular events in patients with stable peripheral or carotid artery disease, but increased the risk of major bleeding. BMJ Evidence-Based Medicine 23(5): 191-192, 2018

Aspirin reduces cardiovascular events in primary prevention of cardiovascular disease but at a near equivalent risk of increased bleeding. Evidence-Based Medicine 21(6): 225, 2016

Aspirin for primary prevention. Doctors and patients should understand potential benefits and risks of aspirin treatment. BMJ 321(7274): 1472-1473, 2001

Cost-effectiveness of aspirin treatment in the primary prevention of cardiovascular disease events in subgroups based on age, gender, and varying cardiovascular risk. Circulation 117(22): 2875-2883, 2008