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Fig. 1 | BMC Medicine

Fig. 1

From: Benefit-harm analysis and charts for individualized and preference-sensitive prevention: example of low dose aspirin for primary prevention of cardiovascular disease and cancer

Fig. 1

Benefit-Harm Chart for low dose aspirin on [http://www.benefit-harm-balance.com]. The Benefit-Harm Charts inform about the benefit-harm balance of low dose aspirin based on a patient’s risk profile. Benefit outcomes are (prevented) MI, severe ischemic stroke, and cancers, and harm outcomes are (excess) severe GI bleed and severe hemorrhagic stroke. In the first step the risk profile of an individual is determined using risk factors for the benefit and harm outcomes. Ideally, and to facilitate risk prediction, a computer processes the information on risk factors saved in the electronic patient chart and provides the 10-year risk estimates. In this example, the 60-year old woman has a 10-year risk of 6 % for MI, 6 % for severe ischemic stroke, 0.03 % for hemorrhagic stroke, 5 % for severe GI bleed (non-smoker, high blood pressure treated with atenolol tablet 50 mg per day, no diabetes, no history of gastric ulcer, no atrial fibrillation, no left-ventricular hypertrophy but chronic lower back pain; systolic blood pressure 145 mm Hg, total cholesterol 170 mg/dL, HDL cholesterol 55 mg/dL, takes ibuprofen tablet 200 mg twice a day. She eats vegetables regularly and is physically active. There is no prior history of colorectal cancer in her family). Using the online calculator [http://www.benefit-harm-balance.com] the Benefit-Harm Chart shows for specific outcome preferences (rulers on top) and for each combination of outcome risks (four 5x5 tables) the probability that aspirin provides more benefits than harms (red colored cells <40 % of the 100,000 repetitions with index >0, yellow colored cells 40–60 %, and green colored cells >60 % probability). For the 60-year old woman, the Benefit-Harm Chart shows that she is likely to experience more harms than benefits from aspirin

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