Biccler Jorne, Bollaerts Kaatje, Vora Pareen, Sole Elodie, Rodriguez Luis Alberto Garcia, Lanas Angel, Langley Ruth E, Gabarró Montse Soriano
P95 Epidemiology and Pharmacovigilance, Leuven, Belgium.
Bayer AG, Epidemiology, Integrated Evidence Generation, Berlin, Germany.
Int J Cardiol Heart Vasc. 2021 Aug 3;36:100851. doi: 10.1016/j.ijcha.2021.100851. eCollection 2021 Oct.
Low-dose aspirin therapy reduces the risk of cardiovascular disease and may have a positive effect on the prevention of colorectal cancer. We evaluated the population-level expected effect of regular low-dose aspirin use on cardiovascular disease (CVD), colorectal cancer (CRC), gastrointestinal bleeding, symptomatic peptic ulcers, and intracranial hemorrhage, using a microsimulation study design.
We used individual-level state transition modeling to assess the impact of aspirin in populations aged 50-59 or 60-69 years old indicated for low-dose aspirin usage for primary or secondary CVD prevention. Model parameters were based on data from governmental agencies from the UK or recent publications.
In the 50-59 years cohort, a decrease in incidence rates (IRs per 100 000 person years) of non-fatal CVD (-203 and -794) and fatal CVD (-97 and-381) was reported in the primary and secondary CVD prevention setting, respectively. The IR reduction of CRC (-96 and -93) was similar for primary and secondary CVD prevention. The IR increase of non-fatal (116 and 119) and fatal safety events (6 and 6) was similar for primary and secondary CVD prevention. Similar results were obtained for the 60-69 years cohort.
The decrease in fatal CVD and CRC events was larger than the increase in fatal safety events and this difference was more pronounced when low-dose aspirin was used for secondary compared to primary CVD prevention. These results provide a comprehensive image of the expected effect of regular low-dose aspirin therapy in a UK population indicated to use aspirin for CVD prevention.
低剂量阿司匹林疗法可降低心血管疾病风险，且可能对预防结直肠癌有积极作用。我们采用微观模拟研究设计，评估了常规使用低剂量阿司匹林对心血管疾病（CVD）、结直肠癌（CRC）、胃肠道出血、症状性消化性溃疡和颅内出血的人群水平预期效果。
我们使用个体水平的状态转换模型，评估阿司匹林对年龄在50 - 59岁或60 - 69岁、因一级或二级CVD预防而使用低剂量阿司匹林的人群的影响。模型参数基于英国政府机构的数据或近期出版物。
在50 - 59岁队列中，一级和二级CVD预防组分别报告非致命性CVD（每10万人年发病率分别降低203和794）和致命性CVD（每10万人年发病率分别降低97和381）的发病率下降。一级和二级CVD预防组的CRC发病率降低（分别为96和93）相似。一级和二级CVD预防组非致命性（分别为116和119）和致命性安全事件（分别为6和6）的发病率增加相似。60 - 69岁队列也获得了类似结果。
致命性CVD和CRC事件的减少大于致命性安全事件的增加，且与一级CVD预防相比，低剂量阿司匹林用于二级预防时这种差异更为明显。这些结果全面展示了在英国人群中常规使用低剂量阿司匹林疗法预防CVD的预期效果。
