Projects

USPSTF updates its recommendation on aspirin use to prevent CVD

Recommendations on aspirin use for primary prevention of cardiovascular disease (CVD) have changed numerous times over the past decades. On April 26, 2022 the US Preventive Services Task Force (USPSTF) which is an independent, voluntary body has published a new recommendation statement on aspirin use to prevent CVD. Since its previous update in 2016, three large placebo-controlled randomized clinical trials of primary prevention with aspirin (ARRIVE, ASPREE and ASCEND) were published which cast doubt about net benefit for aspirin prophylaxis in current practice. The new USPSTF statement was published online in the Journal of the American Medical Association along with an evidence review, a modeling study, a patient page, and an editorial. The population concerned includes adults 40 years or older without signs or symptoms of CVD or known CVD (including history of myocardial infarction or stroke) who are not at increased risk for bleeding (eg, no history of gastrointestinal ulcers, recent bleeding, other medical conditions, or use of medications that increase bleeding risk).

The USPSTF concludes with moderate certainty that aspirin use for the primary prevention of CVD events in adults aged 40 to 59 years who have a 10% or greater 10-year CVD risk has a small net benefit. The USPSTF concludes with moderate certainty that initiating aspirin use for the primary prevention of CVD events in adults 60 years or older has no net benefit.

Consequently, the decision to initiate low-dose aspirin use for the primary prevention of CVD in adults aged 40 to 59 years who have a 10% or greater 10-year CVD risk should be an individual one. As for older patients, the USPSTF recommends against initiating low-dose aspirin use for the primary prevention of CVD in adults 60 years or older. For persons who have initiated aspirin use, the net benefits continue to accrue over time in the absence of a bleeding event. The net benefits, however, generally become progressively smaller with advancing age because of an increased risk for bleeding, and modeling data suggest that it may be reasonable to consider stopping aspirin use around age 75 years.

Reference: https://jamanetwork.com/journals/jama/fullarticle/2791399

Back to the list