USPSTF releases update on aspirin use to prevent cardiovascular disease and colorectal cancer

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An updated statement from the U.S. Preventive Services Task Force (USPSTF) recommends healthcare professionals initiate daily, low-dose aspirin for primary prevention of cardiovascular disease and colorectal cancer in adults who are between 50 and 59 years old and have a 10 percent or greater 10-year cardiovascular disease risk.

The recommendation applies to adults in that age category who are not at increased risk for bleeding, have a life expectancy of at least 10 years and are willing to low-dose aspirin every day for at least 10 years. The researchers recommended prescribing 81 mg of aspirin per day and assessing cardiovascular disease and bleeding risk factors.

Lead researcher Albert L. Siu, MD, of the USPSTF, and colleagues simultaneously published their findings online in the Annals of Internal Medicine on April 11. For this analysis, the USPSTF researchers examined three systematic evidence reviews and a decision-analysis model.

They noted that adults between 60 and 69 years who have a 10 percent or greater cardiovascular disease risk should make individual decisions on whether to take low-dose aspirin for primary prevention of cardiovascular disease and colorectal cancer. For that age category, the main benefit of daily aspirin would be in adults who are not at increased risk for bleeding, have a life expectancy of at least 10 years and are willing to take low-dose aspirin daily for at least 10 years.

They also mentioned that the current evidence was insufficient to determine if the risks of daily low-dose aspirin as primary prevention for cardiovascular disease and colorectal cancer would outweigh the harms in adults who were younger than 50 years old or older than 70 years old.

To predict the 10-year risk for a first atherosclerotic cardiovascular disease event, the USPSTF researchers used a calculator derived from the American College of Cardiology/American Heart Association pooled cohort equations. They defined a first atherosclerotic cardiovascular disease event as nonfatal MI, coronary heart disease death and fatal or nonfatal stroke.

They said the primary risk factors for cardiovascular disease are older age, male sex, race/ethnicity, abnormal lipid levels, high blood pressure, diabetes and smoking. In addition, the risk factors for gastrointestinal bleeding with aspirin use include higher aspirin dose and longer duration of use, history of gastrointestinal ulcers or upper gastrointestional pain, bleeding disorders, renal failure, severe liver disease and thrombocytopenia.

They wrote that more than 26 million adults have been diagnosed with and are living with heart disease, which accounts for more than 30 percent of all deaths in the U.S. They cited data that showed it cost an estimated $315 billion to treat people with cardiovascular disease in 2010.

The American Heart Association and American Stroke Association recommend low-dose aspirin for cardiovascular prophylaxis in adults with a 10-year cardiovascular disease risk of 6 percent to 10 percent. Meanwhile, the American Diabetes Association recommends low-dose aspirin for primary prevention in patients with type 1 or 2 diabetes and a greater than 10 percent 10-year cardiovascular disease risk who are not at an increased risk for bleeding.