Abstract
BackgroundTo balance the cardiovascular benefits from low-dose aspirin against the gastrointestinal harm caused, studies have considered the coronary heart disease risk for each individual but not their gastrointestinal risk profile. We characterized the gastrointestinal risk profile of low-dose aspirin users in real clinical practice, and estimated the excess risk of upper gastrointestinal complications attributable to aspirin among patients with different gastrointestinal risk profiles.MethodsTo characterize aspirin users in terms of major gastrointestinal risk factors (i.e., advanced age, male sex, prior ulcer history and use of non-steroidal anti-inflammatory drugs), we used The General Practice Research Database in the United Kingdom and the Base de Datos para la Investigación Farmacoepidemiológica en Atención Primaria in Spain. To estimate the baseline risk of upper gastrointestinal complications according to major gastrointestinal risk factors and the excess risk attributable to aspirin within levels of these factors, we used previously published meta-analyses on both absolute and relative risks of upper gastrointestinal complications.ResultsOver 60% of aspirin users are above 60 years of age, 4 to 6% have a recent history of peptic ulcers and over 13% use other non-steroidal anti-inflammatory drugs. The estimated average excess risk of upper gastrointestinal complications attributable to aspirin is around 5 extra cases per 1,000 aspirin users per year. However, the excess risk varies in parallel to the underlying gastrointestinal risk and might be above 10 extra cases per 1,000 person-years in over 10% of aspirin users.ConclusionIn addition to the cardiovascular risk, the underlying gastrointestinal risk factors have to be considered when balancing harms and benefits of aspirin use for an individual patient. The gastrointestinal harms may offset the cardiovascular benefits in certain groups of patients where the gastrointestinal risk is high and the cardiovascular risk is low.
Highlights
To balance the cardiovascular benefits from low-dose aspirin against the gastrointestinal harm caused, studies have considered the coronary heart disease risk for each individual but not their gastrointestinal risk profile
It has been estimated that treating patients with a moderately high baseline risk with aspirin would prevent up to 4 myocardial infarctions per 1,000 persons treated per year, while treating low risk patients would prevent less than 1 event per 1,000 persons treated per year [8]
We describe below i) the distribution of the main risk factors for upper gastrointestinal tract complications (UGIC) among populations of prescription aspirin users, ii) the estimated baseline risk of UGIC within levels of these factors, and iii) the estimated excess risk of UGIC that could be attributed to aspirin within subgroups of aspirin users with specific baseline risks of UGIC
Summary
To balance the cardiovascular benefits from low-dose aspirin against the gastrointestinal harm caused, studies have considered the coronary heart disease risk for each individual but not their gastrointestinal risk profile. BMC Medicine 2006, 4:22 http://www.biomedcentral.com/1741-7015/4/22 with a number of factors including age, sex, blood pressure, cigarette smoking, diabetes, cholesterol levels, and a previous diagnosis of cardiovascular disease [3]. This risk variability is so widely accepted that the specific cardiovascular risk for a given person can be formally estimated using equations currently available on the web [4]. Long-term use of low-dose aspirin reduces the risk of myocardial infarction by about 25%–30% irrespective of the baseline risk [5,6,7], this relative change has a greater absolute impact on persons with an elevated underlying risk. It has been estimated that treating patients with a moderately high baseline risk with aspirin would prevent up to 4 myocardial infarctions per 1,000 persons treated per year, while treating low risk patients would prevent less than 1 event per 1,000 persons treated per year [8]
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