D4 Asprin Therapy

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D4 Asprin Therapy

  1. 1. Clinical Guidelines—Aspirin Use for thePrevention ofCardiovascular Disease
  2. 2. Heart Disease and StrokeBackgroundHeart 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. 2
  3. 3. Heart Disease and StrokeRisk FactorsApproximately 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) 3
  4. 4. Heart Disease and StrokeMortality Rates by Ethnicity (Source: http://www.cdc.gov/heartdisease/facts.htm 3/23/12) 4
  5. 5. Aspirin TherapyBenefitsThe 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. 5
  6. 6. Aspirin TherapyBenefitsThe benefits of aspirin therapy depend substantially on an individual’s risk of cardiovascular disease or stroke and adverse treatment effects. 6
  7. 7. Aspirin TherapyBenefitsUnderstanding whobenefits from aspirinuse, and how much, canhelp clinicians andpatients develop a morepatient-centeredapproach to preventivetherapy. 7
  8. 8. Aspirin TherapyClinical GuidelinesThe USPSTF recommends aspirin therapy for 8
  9. 9. Aspirin TherapyClinical GuidelinesAccording to the USPSTF, 9
  10. 10. Aspirin TherapyRisk of GI Bleeding Age: Increases with age—with or without aspirin therapy Gender: Twice the risk for men 10
  11. 11. Aspirin TherapyRisk of GI BleedingGI Ulcers: 2 to 3 times greater in patients with history of GI ulcersNon-Steroidal Quadruples risk for serious GIAnti-inflammatory bleeding compared to aspirin useDrug (NSAID) Use: aloneOther Factors: History or presence of upper GI tract pain, uncontrolled hypertension, and concomitant use of anticoagulants 11
  12. 12. Aspirin Therapy - MenBenefit vs RiskThe net benefit of aspirintherapy for men depends on • the initial risk for coronary heart disease (CHD) events and • GI bleeding. 12
  13. 13. Aspirin Therapy - MenRisk Factors for CHD 13
  14. 14. Aspirin Therapy - MenRisk Factors for CHDTools to determine individual risk for CHD National Cholesterol Education Program Million Hearts 14
  15. 15. Aspirin Therapy - WomenBenefit vs RiskThe net benefit of aspirintherapy for womendepends on• the initial risk for stroke and• GI bleeding. 15
  16. 16. WomenRisk Factors for Stroke 16
  17. 17. Aspirin Therapy - WomenRisk Factors for StrokeTools to determine individual risk for strokePersonal Stroke Risk 17
  18. 18. Aspirin TherapyWeighing BenefitsUltimately, aspirintherapy is the patient’schoice. 18
  19. 19. Aspirin TherapyWeighing BenefitsEstimated 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) 19
  20. 20. Aspirin TherapyWeighing BenefitsEstimated number ofstrokes preventedaccording to the strokerisk level in women aged45 to 79 years.(Source: http://www.uspreventiveservicestaskforce.org/uspstf09/aspirincvd/aspcvdrsf4.htm) 20
  21. 21. Aspirin TherapyWeighing BenefitsThose with a high likelihoodof benefiting with littlepotential for harm should beencouraged to consideraspirin. 21
  22. 22. Aspirin TherapyWeighing BenefitsAspirin should be discouragedamong those with littlepotential of benefiting or ahigh risk of GI bleeding. 22
  23. 23. Aspirin TherapyWeighing BenefitsSome might decide thatavoiding a heart attack orstroke is of greater value thanhaving GI bleeding. 23
  24. 24. Aspirin TherapyWeighing BenefitsEncourage shareddecision-making withthose whose potentialbenefits and risks forserious GI bleeding aremore closely balanced. 24
  25. 25. Aspirin TherapyDose/DosageAccording 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. 25
  26. 26. RememberUnderstanding whobenefits from aspirinuse, and how much, canhelp clinicians andpatients develop a morepatient-centeredapproach to preventivetherapy. 26
  27. 27. Questions/Comments?Sandy Pogonesspogones@primaris.org314-374-6451 27
  28. 28. ResourcesU.S. Preventative Services Task Force (USPSTF) Aspirin for the Prevention of Cardiovascular DiseaseCenters for Disease Control Recommendations for Aspirin for Prevention of Cardiovascular Disease Million HeartsPubMed.gov Individual and Population Benefits of Daily Aspirin Therapy: a Proposal for Personalizing National Guidelines 28

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