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

doi:10.1136/bmj.38456.676806.8F

BMJ 2005;330:1306 (4 June), doi:10.1136/bmj.38456.676806.8F (published 20 May 2005)

Primary care

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

Mark R Nelson, chair¹, Danny Liew, senior lecturer², Melanie Bertram, technical officer³, Theo Vos, associate professor⁴

¹ Discipline of General Practice, School of Medicine, University of Tasmania, Hobart, TAS 7001, Australia, ² Department of Epidemiology and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, VIC 3004, Australia, ³ World Health Organization, 1211 Geneva 27, Switzerland, ⁴ School of Population Health, University of Queensland, Herston, QLD 4006, Australia

Correspondence to: M R Nelson Mark.Nelson{at}utas.edu.au

Objective To investigate the routine use of low dose aspirinin people aged $≥$ 70 without overt cardiovascular disease.

Design Epidemiological modelling in a hypothetical population.

Setting Reference populations of men and women in the year 2000from the state of Victoria, Australia.

Subjects 10 000 men and 10 000 women aged 70-74 with no cardiovasculardisease.

Main outcome measures First ever myocardial infarction or unstableangina, ischaemic or haemorrhagic stroke, and major gastrointestinalhaemorrhage. Health adjusted years of life lived.

Results The proportional benefit gained from the use of lowdose aspirin by the prevention of myocardial infarctions (-389in 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 takeinto account length and quality of life) are equivocal for aspirincausing net harm or net benefit.

Conclusion Epidemiological modelling suggests that any benefitsof low dose aspirin on risk of cardiovascular disease in peopleaged $≥$ 70 are offset by adverse events. These findings are temperedby wide confidence intervals, indicating that the overall outcomecould be beneficial or adverse.

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