The document discusses guidelines for aspirin use in cardiovascular disease prevention. It outlines that aspirin decreases heart attacks in men and strokes in women, but also increases gastrointestinal bleeding and hemorrhagic strokes. The benefits of aspirin therapy depend on an individual's cardiovascular risk factors and risk of adverse effects. The USPSTF recommends aspirin for those at higher risk, but advises weighing risks versus benefits for those at intermediate risk through shared decision-making. The optimal aspirin dose for prevention is uncertain, but 75mg per day appears effective.

1. Clinical Guidelines—
Aspirin Use for the
Prevention of
Cardiovascular Disease

2. Heart Disease and Stroke
Background
Heart 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. Heart Disease and Stroke
Risk Factors
Approximately 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. Heart Disease and Stroke
Mortality Rates by Ethnicity
(Source: http://www.cdc.gov/heartdisease/facts.htm 3/23/12)
4

5. Aspirin Therapy
Benefits
The 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. Aspirin Therapy
Benefits
The benefits of aspirin therapy depend substantially
on an individual’s risk of cardiovascular disease or
stroke and adverse treatment effects.
6

7. Aspirin Therapy
Benefits
Understanding who
benefits from aspirin
use, and how much, can
help clinicians and
patients develop a more
patient-centered
approach to preventive
therapy.
7

8. Aspirin Therapy
Clinical Guidelines
The USPSTF recommends aspirin therapy for
8

9. Aspirin Therapy
Clinical Guidelines
According to the USPSTF,
9

10. Aspirin Therapy
Risk of GI Bleeding
Age: Increases with age—with
or without aspirin therapy
Gender: Twice the risk for men
10

11. Aspirin Therapy
Risk of GI Bleeding
GI Ulcers: 2 to 3 times greater in patients with
history of GI ulcers
Non-Steroidal Quadruples risk for serious GI
Anti-inflammatory bleeding compared to aspirin use
Drug (NSAID) Use: alone
Other Factors: History or presence of upper GI tract
pain, uncontrolled hypertension, and
concomitant use of anticoagulants
11

12. Aspirin Therapy - Men
Benefit vs Risk
The net benefit of aspirin
therapy for men depends on
• the initial risk for
coronary heart disease
(CHD) events and
• GI bleeding.
12

13. Aspirin Therapy - Men
Risk Factors for CHD
13

14. Aspirin Therapy - Men
Risk Factors for CHD
Tools to determine individual risk for CHD
National Cholesterol Education Program
Million Hearts
14

15. Aspirin Therapy - Women
Benefit vs Risk
The net benefit of aspirin
therapy for women
depends on
• the initial risk for stroke
and
• GI bleeding.
15

16. Women
Risk Factors for Stroke
16

17. Aspirin Therapy - Women
Risk Factors for Stroke
Tools to determine individual risk for stroke
Personal
Stroke
Risk
17

18. Aspirin Therapy
Weighing Benefits
Ultimately, aspirin
therapy is the patient’s
choice.
18

19. Aspirin Therapy
Weighing Benefits
Estimated heart attacks
prevented and estimated
harms of using aspirin for
10 years in a hypothetical
cohort of 1000 men aged
45-79 years.
(Source: http://www.uspreventiveservicetaskforce.org/uspstf09/aspirincvd.aspcvdrsf2.htm)
19

20. Aspirin Therapy
Weighing Benefits
Estimated number of
strokes prevented
according to the stroke
risk level in women aged
45 to 79 years.
(Source: http://www.uspreventiveservicestaskforce.org/uspstf09/aspirincvd/aspcvdrsf4.htm)
20

21. Aspirin Therapy
Weighing Benefits
Those with a high likelihood
of benefiting with little
potential for harm should be
encouraged to consider
aspirin.
21

22. Aspirin Therapy
Weighing Benefits
Aspirin should be
discouraged
among those with little
potential of benefiting or a
high risk of GI bleeding.
22

23. Aspirin Therapy
Weighing Benefits
Some might decide that
avoiding a heart attack or
stroke is of greater value than
having GI bleeding.
23

24. Aspirin Therapy
Weighing Benefits
Encourage shared
decision-making with
those whose potential
benefits and risks for
serious GI bleeding are
more closely balanced.
24

25. Aspirin Therapy
Dose/Dosage
According 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. Remember
Understanding who
benefits from aspirin
use, and how much, can
help clinicians and
patients develop a more
patient-centered
approach to preventive
therapy.
26

27. Questions/Comments?
Sandy Pogones
spogones@primaris.org
314-374-6451
27

28. Resources
U.S. Preventative Services Task Force (USPSTF)
Aspirin for the Prevention of Cardiovascular Disease
Centers for Disease Control
Recommendations for Aspirin for Prevention of Cardiovascular Disease
Million Hearts
PubMed.gov Individual and Population Benefits of Daily Aspirin
Therapy: a Proposal for Personalizing National Guidelines
28