The U.S. Preventive Services Task Force (USPSTF) has published its final recommendation statement on the practice of taking daily low-dose aspirin to prevent cardiovascular disease (CVD).
For high-risk patients between the ages of 40 to 59 with no prior history of CVD, the USPSTF concluded with “moderate certainty” that taking daily low-dose aspirin is associated with a “small net benefit.” This represents the group’s C grade, meaning that it ultimately comes down to each individual patient’s situation and a healthcare professional should be consulted before making any final decision.
The USPSTF does not recommended that patients 60 years old or older with no prior history of CVD take aspirin for this specific purpose, however, because it was linked to “no net benefit.” This represents the group’s D grade.
“Based on current evidence, the USPSTF recommends against people 60 and older starting to take aspirin to prevent a first heart attack or stroke,” USPSTF vice chair Michael Barry, MD, a professor of medicine at Harvard Medical School and director of the Informed Medical Decisions program at Massachusetts General Hospital, said in a statement. “Because the chance of internal bleeding increases with age, the potential harms of aspirin use cancel out the benefits in this age group.”
These recommendations, the group emphasized, do not include patients with a history of CVD or those who are already taking aspirin for another reason.
“Anyone who already takes aspirin and has questions about it should speak with their healthcare professional,” added USPSTF representative John Wong, MD, interim chief scientific officer and vice chair of academic affairs at Tufts Medical Center and a professor of medicine at Tufts University School of Medicine.
The full USPSTF recommendation statement is available in JAMA. A full evidence report is also available.
Previous USPSTF recommendations on aspirin
These updated recommendations give healthcare providers and patients alike an update to the 2016 USPSTF recommendations on aspirin use to prevent CVD. Previously, the group recommended that all high-risk adults 50 to 59 years old with no increased risk for bleeding and a life expectancy of at least 10 years start taking low-dose aspirin. The USPSTF also previously said that high-risk patients ages 60 to 69 start may want to start taking low-dose aspirin to prevent CVD, but the decision should be made on a case-by-case basis.
To develop this updated statement, USPSTF representatives commissioned a systematic review on the effectiveness of low-dose aspirin as a preventive measure and a “microsimulation modeling study to assess the net balance of benefits and harms.”
Evidence from 13 different randomized clinical trials involving more than 161,000 patients was included in the group’s analysis.
The American Heart Association responds
The American Heart Association (AHA) issued its own statement on the USPSTF’s new recommendations, highlighting the fact that any patients already taking low-dose aspirin due to a history of heart attack, stroke, stenting or atrial fibrillation should continue to take the medication as recommended.
“Do not stop taking aspirin without first talking with your doctor,” wrote AHA President Donald M. Lloyd-Jones, MD, ScM, chair of the department of preventive medicine at Northwestern University’s Feinberg School of Medicine in Chicago.
The AHA statement also noted that “healthy lifestyle changes” still remain the most significant way to reduce the risk of CVD.
“Eating healthy foods and beverages, regular physical activity and not smoking are key,” Jones said. “The scientific evidence continues to confirm healthy lifestyle habits and effectively managing blood pressure and cholesterol are the top ways to prevent a first heart attack or stroke, not low-dose aspirin.”
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Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.