Dr. Gujral's Speciality Clinics

The following are 10 points to remember about aspirin for the prevention of cardiovascular disease:

1. The lifetime risk of cardiovascular events in adults older than 40 years is two in three for men and more than one in two for women.

2. These U.S. Preventive Services Task Force recommendations are for men and women without known coronary disease or stroke, and based on a 32% reduction in risk of myocardial infarction (MI) in men and a 17% reduction in stroke in women with regular aspirin use.

3. Estimated gastrointestinal (GI) bleeds per 1,000 men would be 8 at 45-59 years, 24 at 60-69 years, and 36 at 70-79 years; and for 1,000 women: 4, 12, and 18, respectively. The risks of GI bleeding were developed assuming no use of nonsteroidal anti-inflammatory drugs or other conditions associated with increased risk of GI bleeding.

4. Encourage men ages 45-79 years to use aspirin when the potential benefit of a reduction in MIs outweighs the potential harm of an increase in GI hemorrhage (GI bleeds) (Level A recommendation).

5. The value of aspirin for reducing MI would exceed risk of GI bleeding if 10-year risk is ≥4% in men 45-59 years, ≥9% in men 60-69 years, and ≥12% in men 70-79 years.

6. Encourage women ages 55-79 years to use aspirin when the potential benefit of a reduction in ischemic strokes outweighs the potential harm of an increase in GI hemorrhage (Level A recommendation).

7. The value of aspirin for reducing strokes in women would exceed risk of bleeding if the 10-year risk is ≥3% for women 45-59 years, ≥8% for women 60-69 years, and ≥11% for women 70-79 years.

8. The optimal dose of aspirin is not known, but a dose of about 75 mg/d seems as effective as higher doses, which may increase risk of GI bleeding.

9. Evidence is insufficient to assess the balance of benefits and harms of aspirin for cardiovascular disease prevention in men and women ages 80 years or older. Do not encourage aspirin use for cardiovascular disease prevention in women younger than 55 years and in men younger than 45 years (Level D recommendation).

10. Clinicians and policymakers should understand the evidence, but individualize decision making to the specific patient or situation. Melvyn Rubenfire, M.D., F.A.C.C.