Aspirin Use to Prevent Cardiovascular Disease: US Preventive Services Task Force Recommendation Statement

Area of Science:

• Preventive Medicine
• Cardiology
• Gastroenterology

Background:

• Cardiovascular disease (CVD) is a leading cause of mortality in the US.
• An estimated 605,000 and 610,000 individuals experience myocardial infarction and stroke annually, respectively.
• Aspirin is commonly used for CVD prevention, necessitating updated recommendations.

Purpose of the Study:

• To update the 2016 US Preventive Services Task Force (USPSTF) recommendation on aspirin for primary CVD prevention.
• To evaluate aspirin's effectiveness in reducing CVD events, cardiovascular mortality, and all-cause mortality.
• To assess aspirin's impact on colorectal cancer (CRC) and associated harms, particularly bleeding.

Main Methods:

• A systematic review was conducted to assess aspirin's efficacy and harms for primary CVD prevention.
• A microsimulation modeling study evaluated the net balance of benefits and harms.
• The analysis stratified outcomes by age, sex, and CVD risk level.

Main Results:

• Aspirin use shows a small net benefit for primary CVD prevention in adults aged 40-59 with a 10% or greater 10-year CVD risk.
• Initiating aspirin for primary CVD prevention in adults 60 years or older demonstrates no net benefit.
• The risk of bleeding is a significant harm associated with aspirin use.

Conclusions:

• The decision to initiate low-dose aspirin for primary CVD prevention in adults 40-59 with high risk should be individualized.
• Individuals without increased bleeding risk who are willing to take daily low-dose aspirin may experience a small net benefit.
• The USPSTF recommends against initiating low-dose aspirin for primary CVD prevention in adults 60 and older.