The US Preventive Services Task Force (USPSTF) has released a final recommendation statement on aspirin use to prevent cardiovascular disease (CVD).
The USPSTF recommends that individuals 40 to 59 years of age who are at higher risk for CVD and do not have a history of CVD should consult with their health care provider on whether to start taking low dose aspirin to prevent a first heart attack or stroke (Grade C). For individuals 60 years of age and older, the USPSTF recommends against initiating low dose aspirin for heart disease and stroke prevention (Grade D). These recommendations only apply to individuals 40 years or older who do not have a history of CVD and are not already taking daily aspirin.
To assess the efficacy of aspirin to reduce the risk of CVD events, cardiovascular mortality, and all-cause mortality in individuals without a history of CVD, the USPSTF conducted a systematic review of randomized clinical trials. The effect of aspirin use on colorectal cancer (CRC) incidence and mortality in primary CVD prevention populations, and the harms associated with aspirin use were also evaluated in the review. Moreover, a microsimulation modeling study was conducted to assess the net balance of benefits and harms from aspirin use stratified by age, sex, and CVD risk level.
According to new evidence, the USPSTF concluded with moderate certainty that there was a small net benefit for aspirin use for the primary prevention of CVD in adults 40 to 59 years of age who have a 10% or greater 10-year CVD risk. Individuals who are not at increased risk for bleeding and are willing to take low dose aspirin daily were more likely to benefit.
According to the USPSTF, decisions about starting aspirin should be based on shared decision-making that includes a discussion about the potential benefits and harms. A dose of 81mg/day is considered to be reasonable for patients who place a higher value on the potential benefits of aspirin use.
The USPSTF also concluded with moderate certainty that there was no net benefit for initiating aspirin use for the primary prevention of CVD in adults 60 years of age and older. “Because the chance of internal bleeding increases with age, the potential harms of aspirin use cancel out the benefits in this age group,” said Task Force vice chair Michael Barry, MD.
Additionally, the USPSTF concluded that the evidence is unclear as to whether low dose aspirin reduces CRC incidence or mortality.
- Task Force finalizes recommendations on starting aspirin use to prevent a first heart attack or stroke. News release. US Preventive Services Task Force. Accessed April 26, 2022. https://www.uspreventiveservicestaskforce.org/uspstf/sites/default/files/file/supporting_documents/aspirin-cvd-prevention-final-rec-bulletin_0.pdf
- Aspirin use to prevent cardiovascular disease: US Preventive Services Task Force recommendation statement. JAMA. Published online April 26, 2022. doi:10.1001/jama.2022.4983