#VisualAbstract: Personalized Prediction of Cardiovascular Benefits and Bleeding Harms From Aspirin for Primary Prevention

1. The benefit of daily aspirin varied dramatically depending on whether one cardiovascular disease event was equivalent to one or two bleeding events

2. Subgroups that tended to benefit more from aspirin treatment included patients with cardiovascular disease risk factors such as hyperlipidemia, hypertension, diabetes, smokers) and those with lower bleeding risk factors.

Evidence Rating Level: 1 (Excellent)  

Study Rundown: Aspirin reduces the risk of cardiovascular disease (CVD) in at-risk patients while increasing the risk of bleeding, but it is unclear if aspirin benefits outweigh the risks in patients without known CVD. This study found that when a CVD event was considered equivalent to 2 major bleeding events, net benefits of aspirin increased to 21% of women and 41% of men. Patients with more CVD risk factors (including hyperlipidemia, hypertension, diabetes, smokers) and those with lower bleeding risk factors benefited more from aspirin treatment. Despite the significance of these results, one limitation of this study was the generalizability of findings given that the study took place in a New Zealand primary care setting. Further, because the study design incorporated hemorrhagic stroke as an outcome for CVD and bleeding risk scores, the true proportion of patients who experienced a net benefit may be higher than reported. Future studies should further compare the threshold of CVD risk above which aspirin is beneficial to the threshold of bleeding risk above which aspirin is harmful. To help make these decisions at present, it is important for both the clinician and patient to discuss the risks and benefits of aspirin to decide what is best for them.

Click to read the study in Annals of Internal Medicine

Click to read an accompanying editorial in Annals of Internal Medicine

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