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, 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 ¹, Danny Liew ², Melanie Bertram ³, Theo Vos ⁴

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

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

DesignEpidemiological modelling in a hypothetical population.

SettingReference populations of men and women in the year 2000 fromthe state of Victoria, Australia.

Subjects 10 000 men and 10000 women aged 70-74 with no cardiovascular disease.

Main outcomemeasures First ever myocardial infarction or unstable angina,ischaemic or haemorrhagic stroke, and major gastrointestinalhaemorrhage. Health adjusted years of life lived.

Results Theproportional benefit gained from the use of low dose aspirinby the prevention of myocardial infarctions (-389 in men, -321in 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 resultsin health adjusted years of life lived (which take into accountlength and quality of life) are equivocal for aspirin causingnet harm or net benefit.

Conclusion Epidemiological modellingsuggests that any benefits of low dose aspirin on risk of cardiovasculardisease in people aged $≥$ 70 are offset by adverse events. Thesefindings are tempered by wide confidence intervals, indicatingthat the overall outcome could be beneficial or adverse.

(Accepted 13 April 2005)

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