Abstract 16427: The Public Health Implications of Aspirin in Women: Balancing Strokes and Bleeds in the U.S.
Introduction: The 2009 United States Preventive Services Task Force guideline recommends prescribing aspirin for women whose rate of strokes prevented outweighs their increased risk of GI bleeding.
Objective: We sought to determine the number of women in the United States for whom aspirin would be recommended and the number of strokes prevented by treatment. Further, the clinical impact of NSAIDS and acid reduction medications was assessed.
Methods: We used the 2005–2006 National Health and Nutrition Examination Survey (NHANES) to estimate United States women aged 55–79 years who are free of cardiovascular disease. We calculated their ten-year stroke risk reduction and increased GI bleed risk to find the subset of women for whom aspirin is recommended. Increased GI bleed rates were assigned to those on NSAIDS and acid reduction medication and absolute numbers of predicted strokes and bleeds was estimated using a weighted risk model.
Results: A total represented cohort of 23.2 million (M) women met criteria for consideration. Of these, 7.0M (30%) have a stroke risk reduction that eclipses the increased GI bleed risk and should receive aspirin for primary stroke prevention. Of the 2.2M (9.4%) on NSAIDS, just 28,000 (1% of group) qualify for aspirin. Of the 3.3M (14%) taking acid reduction medications, 187,000 (6% of subgroup) should be on aspirin. Treating all 7.0M women with aspirin is predicted to prevent 131,000 strokes in 10 years, while adding 78,000 bleeds. Giving aspirin to the remaining 16.2M women not recommended for aspirin by guideline would prevent 126,000 strokes, but cause 310,000 additional bleeds.
Conclusions: An estimated 325,000 new strokes occurred in women in 2006 per AHA statistics published in 2010. Using the NHANES survey of US women in the same year, about 13,000 could be prevented by appropriate use of aspirin that year. Women taking NSAIDS or acid reducers are unlikely (1% and 6% respectively) to qualify for aspirin. For the remaining 17.7 M however, 38% qualify for aspirin use making universal assessment an appropriate clinical step.
- © 2010 by American Heart Association, Inc.