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Cardioprotective aspirin users and their excess risk of upper gastrointestinal complications.

Hernández-Díaz S, García Rodríguez LA - BMC Med (2006)

Bottom Line: 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.In 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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA. shernan@hsph.harvard.edu

ABSTRACT

Background: 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. 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.

Methods: To 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.

Results: Over 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.

Conclusion: In 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.

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Distribution of risk factors for upper gastrointestinal tract complications (UGIC) among cardioprotective aspirin users in the UK (General Practice Research Database; GPRD) and Spain (Base de Datos para la Investigación Farmacoepidemiológica en Atención Primaria; BIFAP).
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Figure 2: Distribution of risk factors for upper gastrointestinal tract complications (UGIC) among cardioprotective aspirin users in the UK (General Practice Research Database; GPRD) and Spain (Base de Datos para la Investigación Farmacoepidemiológica en Atención Primaria; BIFAP).

Mentions: The distribution of gastrointestinal risk factors among cardioprotection aspirin users is presented in Figure 2. Overall, the proportion of aspirin users above 60 years of age was 88% in the GPRD and 79% in BIFAP. The proportion of males was 52% in the GPRD and 54% in BIFAP. The proportion of aspirin users with a recorded history of gastrointestinal ulcer was 3.8% in the GPRD and 5.9% in BIFAP. The proportion of aspirin users with a recorded past episode of UGIC was 1.2% in the GPRD and 1.9% in BIFAP. The proportion of aspirin users concomitantly using NSAIDs was 14.8% in the GPRD and 13.2% in BIFAP. NSAID use was not included in the figure to simplify the presentation.


Cardioprotective aspirin users and their excess risk of upper gastrointestinal complications.

Hernández-Díaz S, García Rodríguez LA - BMC Med (2006)

Distribution of risk factors for upper gastrointestinal tract complications (UGIC) among cardioprotective aspirin users in the UK (General Practice Research Database; GPRD) and Spain (Base de Datos para la Investigación Farmacoepidemiológica en Atención Primaria; BIFAP).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC1590044&req=5

Figure 2: Distribution of risk factors for upper gastrointestinal tract complications (UGIC) among cardioprotective aspirin users in the UK (General Practice Research Database; GPRD) and Spain (Base de Datos para la Investigación Farmacoepidemiológica en Atención Primaria; BIFAP).
Mentions: The distribution of gastrointestinal risk factors among cardioprotection aspirin users is presented in Figure 2. Overall, the proportion of aspirin users above 60 years of age was 88% in the GPRD and 79% in BIFAP. The proportion of males was 52% in the GPRD and 54% in BIFAP. The proportion of aspirin users with a recorded history of gastrointestinal ulcer was 3.8% in the GPRD and 5.9% in BIFAP. The proportion of aspirin users with a recorded past episode of UGIC was 1.2% in the GPRD and 1.9% in BIFAP. The proportion of aspirin users concomitantly using NSAIDs was 14.8% in the GPRD and 13.2% in BIFAP. NSAID use was not included in the figure to simplify the presentation.

Bottom Line: 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.In 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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA. shernan@hsph.harvard.edu

ABSTRACT

Background: 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. 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.

Methods: To 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.

Results: Over 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.

Conclusion: In 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.

Show MeSH
Related in: MedlinePlus