Aspirin for the Prevention of Cardiovascular Disease: U.S. Preventive Services Task Force Recommendation Statement

Abstract

Encourage men age 45 to 79 years to use aspirin when the potential benefit of a reduction in myocardial infarctions outweighs the potential harm of an increase in gastrointestinal hemorrhage. (A recommendation) Encourage women age 55 to 79 years to use aspirin when the potential benefit of a reduction in ischemic strokes outweighs the potential harm of an increase in gastrointestinal hemorrhage. (A recommendation) Evidence is insufficient to assess the balance of benefits and harms of aspirin for cardiovascular disease prevention in men and women 80 years or older. (I statement) Do not encourage aspirin use for cardiovascular disease prevention in women younger than 55 years and in men younger than 45 years. (D recommendation).

Population Trends in Aspirin Use for Cardiovascular Disease Prevention 1980–2009: The Minnesota Heart Survey

“…In a meta‐analysis, investigators observed a significant 12% relative risk reduction in nonfatal cardiovascular events achieved with aspirin use among previously healthy adults 3. These and other studies led the USPSTF in 2009 to recommend low‐dose aspirin for primary prevention in men aged 45 to 79 years and women aged 55 to 79 years7 with similar recommendations from other authoritative bodies 12, 13. Since then, additional analyses also suggest that aspirin use might be associated with a reduction in CVD mortality26 and that this benefit is likely cost‐effective 27…”

“…These bleeding risks are emphasized in the USPSTF report recommending aspirin use for primary prevention. The USPSTF report recommends aspirin use for those with increased Framingham risk scores for CVD 7. Others have recently emphasized these risks 35.…”

“…Aspirin is widely accepted for secondary prevention after a myocardial infarction or stroke 3. After review of data from multiple prospective randomized clinical trials,4, 5, 6 the United States Preventive Services Task Force (USPSTF) in 2009 published a strong 1A recommendation in favor of use of low‐dose aspirin for primary prevention in men aged 45 to 79 years and women aged 55 to 79 years in whom benefit would be anticipated to exceed risk 7. The recommendation in favor of aspirin use was also included in an American Heart Association prevention guidelines,8, 9, 10, 11 the recent Healthy People 2020 plan,12 and the “Million Hearts Initiative” of the Centers for Medicare and Medicaid Services and Centers for Disease Control and Prevention 13…”

Contemporary Primary Prevention Aspirin Use by Cardiovascular Disease Risk: Impact of US Preventive Services Task Force Recommendations, 2007—2015: A Serial, Cross‐sectional Study

“…Regular aspirin use led to a 24% reduction in risk for ischemic stroke in women as demonstrated in the Women's Health Study in 2005 13. These studies and others18, 19, 20 led the US Preventive Services Task Force (USPSTF) in 2009 to develop a class A recommendation for PP aspirin use in men aged 45 to 79 years and women aged 55 to 79 years for whom CVD ischemic event prevention outweighs bleeding risk 21. This recommendation provided a distinctly favorable recommendation for aspirin use compared with the 2002 statement.…”

Within‐the‐Clinic Shared Decision for an Over‐the‐Counter Medication

“…In 2009, the United States Preventive Services Task Force (USPSTF) assigned grade‐A recommendations for the use of aspirin in men ages 45 to 79 years for the prevention of myocardial infarction (MI) and in women ages 55 to 79 years for the prevention of ischemic stroke, in both cases where the prevention risks outweigh the risk of gastrointestinal (GI) bleeding 2. These recommendations are echoed to varying degrees in multiple cardiovascular disease prevention guidelines, including those of the American Heart Association (AHA) 3.…”