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©2013 UpToDate ® Print Email 10-year CHD risk levels at which the number of cardiovascular disease events prevented is closely balanced to the number of serious bleeding events Men Women Age 10-year CHD risk, percent Age 10-year stroke risk, percent 45-59 y ≥4 55-59 y ≥3 60-69 y ≥9 60-69 y ≥8 70-79 y ≥12 70-79 y ≥11 Shared decision making is strongly encouraged with persons whose risk is close to (either above or below) these estimates of 10-year risk levels. As the potential cardiovascular disease reduction benefit increases above harms, the recommendation to take aspirin should become stronger. CHD: coronary heart disease. Reproduced from: US Preventive Services Task Force. Aspirin for the Prevention of Cardiovascular Disease: Recommendation Statement. AHRQ Publication No. 09-05129-EF-2, March 2009. Agency for Healthcare Research and Quality, Rockville, MD. file://www.ahrq.gov/clinic/uspstf09/aspirincvd/aspcvdrs.htm. Estimated number of strokes prevented and estimated harms of using aspirin for 10 years in a hypothetical cohort of 1000 women on the basis of age and 10-year stroke risk Variable Estimated strokes prevented (per 1000 women), n 10-year stroke risk, percent Age 55 to 59 years Age 60 to 69 years Age 70 to 79 years 1 1.7 1.7 1.7 2 3.4 3.4 3.4 3 5.1 5.1 5.1 4 6.8 6.8 6.8 5 8.5 8.5 8.5 6 10.2 10.2 10.2 7 11.9 11.9 11.9 8 13.6 13.6 13.6 9 15.3 15.3 15.3 10 17 17 17 11 18.7 18.7 18.7 12 20.4 20.4 20.4 13 22.1 22.1 22.1 14 23.8 23.8 23.8 15 25.5 25.5 25.5 16 27.2 27.2 27.2 17 28.9 28.9 28.9 18 30.6 30.6 30.6 19 32.3 32.3 32.3 20 34 34 34 Type of event Estimated harms, n GI bleeding 4 12 18

4 6.8 6.8 6.8 5 8.5 8.5 8.5 6 10.2 10.2 10.2 7 11.9 11.9 11.9 8 13.6 13.6 13.6 9 15.3 15.3 15.3 10 17 17 17 11 18.7 18.7 18.7 12 20.4 20.4 20.4 13 22.1 22.1 22.1 14 23.8 23.8 23.8 15 25.5 25.5 25.5 16 27.2 27.2 27.2 17 28.9 28.9 28.9 18 30.6 30.6 30.6 19 32.3 32.3 32.3 20 34 34 34 Type of event Estimated harms, n GI bleeding 4 12 18 As indicated, the estimated number of strokes avoided varies with 10-year stroke risk. The estimated harms of using aspirin vary with age. Therefore, both 10-year stroke risk and age must be considered when determining whether the potential harms of aspirin use outweigh the potential benefit in terms of strokes prevented. The boldfaced numbers indicate the combinations of 10-year stroke risk and age for which the number of harms (GI bleeding) are greater than the number of strokes prevented.* GI: gastrointestinal. * Calculations of estimated benefits and harms rely on assumptions and are by nature somewhat imprecise. Estimates of benefits and harms, especially at the borders of the boldfaced and non-boldfaced areas, should be considered in the full context of clinical decision making and used to stimulate shared decision making. The calculations in the table are based on the following assumptions: that there is a 17 percent risk reduction of strokes with regular aspirin use and that gastrointestinal bleeding includes serious hemorrhage, perforation, or other complications leading to hospitalization or death. Harm of GI bleeding in the table assumes that risk for GI bleeding increases with age and that the women are not taking nonsteroidal anti-inflammatory drugs, do not have upper GI pain, or do not have a history of GI ulcer. "Strokes prevented" is the net reduction of strokes, which includes a decrease in ischemic strokes and a small increase in hemorrhagic strokes. Reproduced from: US Preventive Services Task Force. Aspirin for the Prevention of Cardiovascular Disease: Recommendation Statement. AHRQ Publication No. 09-05129-EF-2, March 2009. Agency for Healthcare Research and Quality, Rockville, MD. file://www.ahrq.gov/clinic/uspstf09/aspirincvd/aspcvdrs.htm. Estimated myocardial infarctions (MIs) prevented and estimated harms of using aspirin for 10 years in a hypothetical cohort of 1000 men Variable Estimated MIs prevented (per 1000 men), n 10-year CHD risk, percent Age 45 to 59 years Age 60 to 69 years Age 70 to 79 years 1 3.2 3.2 3.2 2 6.4 6.4 6.4 3

Reproduced from: US Preventive Services Task Force. Aspirin for the Prevention of Cardiovascular Disease: Recommendation Statement. AHRQ Publication No. 09-05129-EF-2, March 2009. Agency for Healthcare Research and Quality, Rockville, MD. file://www.ahrq.gov/clinic/uspstf09/aspirincvd/aspcvdrs.htm. Estimated myocardial infarctions (MIs) prevented and estimated harms of using aspirin for 10 years in a hypothetical cohort of 1000 men Variable Estimated MIs prevented (per 1000 men), n 10-year CHD risk, percent Age 45 to 59 years Age 60 to 69 years Age 70 to 79 years 1 3.2 3.2 3.2 2 6.4 6.4 6.4 3 9.6 9.6 9.6 4 12.8 12.8 12.8 5 16 16 16 6 19.2 19.2 19.2 7 22.4 22.4 22.4 8 25.6 25.6 25.6 9 28.8 28.8 28.8 10 32 32 32 11 35.2 35.2 35.2 12 38.4 38.4 38.4 13 41.6 41.6 41.6 14 44.8 44.8 44.8 15 48 48 48 16 51.2 51.2 51.2 17 54.4 54.4 54.4 18 57.6 57.6 57.6 19 60.8 60.8 60.8 20 64 64 64 Type of event Estimated harms, n GI bleeding 8 24 36 Hemorrhagic stroke 1 1 1

16 6 19.2 19.2 19.2 7 22.4 22.4 22.4 8 25.6 25.6 25.6 9 28.8 28.8 28.8 10 32 32 32 11 35.2 35.2 35.2 12 38.4 38.4 38.4 13 41.6 41.6 41.6 14 44.8 44.8 44.8 15 48 48 48 16 51.2 51.2 51.2 17 54.4 54.4 54.4 18 57.6 57.6 57.6 19 60.8 60.8 60.8 20 64 64 64 Type of event Estimated harms, n GI bleeding 8 24 36 Hemorrhagic stroke 1 1 1 As indicated, the estimated number of MIs prevented varies with 10-year CHD risk. The estimated harms of using aspirin vary with age. Therefore, both 10-year CHD risk and age must be considered when determining whether the potential harms of aspirin use outweigh the potential benefit in terms of MIs prevented. The boldfaced numbers indicate the combinations of 10-year CHD risk and age for which the number of harms (GI bleeding and hemorrhagic stroke) are greater than or approximately equal to the number of MIs prevented.* CHD: coronary heart disease; GI: gastrointestinal; MI: myocardial infarction. * Calculations of estimated benefits and harms rely on assumptions and are by nature somewhat imprecise. Estimates of benefits and harms, especially at the borders of the boldfaced and non-boldfaced areas, should be considered in the full context of clinical decision making and used to stimulate shared decision making. The calculations in the table are based on the following assumptions: that there is a 32 percent risk reduction of MIs with regular aspirin use and that gastrointestinal bleeding includes serious hemorrhage, perforation, or other complications leading to hospitalization or death. The harm of GI bleeding in the table assumes that the risk for GI bleeding increases with age and that the men are not taking nonsteroidal anti-inflammatory drugs, do not have upper GI pain, or do not have a history of GI ulcer. Estimates are based on age and 10-year CHD risk. Reproduced from: US Preventive Services Task Force. Aspirin for the Prevention of Cardiovascular Disease: Recommendation Statement. AHRQ Publication No. 09-05129-EF-2, March 2009. Agency for Healthcare Research and Quality, Rockville, MD. file://www.ahrq.gov/clinic/uspstf09/aspirincvd/aspcvdrs.htm.

©2013 UpToDate ® Print Email 10-year CHD risk levels at which the number of cardiovascular disease events prevented is closely balanced to the number of serious bleeding events Men Women Age 10-year CHD risk, percent Age 10-year stroke risk, percent 45-59 y ≥4 55-59 y ≥3 60-69 y ≥9 60-69 y ≥8 70-79 y ≥12 70-79 y ≥11 Shared decision making is strongly encouraged with persons whose risk is close to (either above or below) these estimates of 10-year risk levels. As the potential cardiovascular disease reduction benefit increases above harms, the recommendation to take aspirin should become stronger. CHD: coronary heart disease. Reproduced from: US Preventive Services Task Force. Aspirin for the Prevention of Cardiovascular Disease: Recommendation Statement. AHRQ Publication No. 09-05129-EF-2, March 2009. Agency for Healthcare Research and Quality, Rockville, MD. file://www.ahrq.gov/clinic/uspstf09/aspirincvd/aspcvdrs.htm.