Starting Aspirin in Patients 60 or Older for Primary CVD Prevention Not Recommended


The US Preventive Services Task Force (USPSTF) has released an updated draft recommendation statement on the use of aspirin to prevent cardiovascular disease (CVD).

The USPSTF recommends that individuals 40 to 59 years of age who are at higher risk for CVD and do not have a history of CVD consult with their health care provider on whether to start taking aspirin (Grade C; depending on individual circumstances). Evidence shows a closer balance of risks and benefits for starting aspirin in individuals 40 to 59 years of age. This recommendation only applies to individuals who are at higher risk for CVD, have no history of CVD, and are not already taking daily aspirin. Age, heart disease risk, and bleeding risk should all be factored into the decision, as well as patient preferences.

For individuals 60 years of age and older, the USPSTF recommends not starting aspirin for heart disease and stroke prevention (Grade D; not recommended) as new evidence suggests that the risk of bleeding outweighs the benefit of protection in these individuals. The recommendation does not apply to patients with prior atherosclerotic cardiovascular disease; these patients should continue to take aspirin unless otherwise instructed.


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Weighing in on the draft recommendations, the American Heart Association/American Stroke Association volunteer President Donald M. Lloyd-Jones, MD, ScM, FAHA, said: “As detailed in the American College of Cardiology/American Heart Association’s 2019 primary prevention recommendations, recent large trials indicate that, in the current environment, the overall benefit of aspirin is small; in most adults the benefit of protection against heart attacks and strokes is offset by the potential risk of bleeding caused by aspirin. As a result, aspirin should be used rarely to help prevent heart attacks and stroke among adults ages 40 to 70 without known cardiovascular disease.” 

The draft recommendation statement and evidence review have been posted for public comment on the USPSTF website. Comments can be submitted through November 8, 2021.

References

  1. Task Force issues draft recommendation statement on aspirin use to prevent cardiovascular disease. News release. US Preventive Services Task Force. Accessed October 13, 2021. https://www.uspreventiveservicestaskforce.org/uspstf/sites/default/files/file/supporting_documents/aspirin-cvd-prevention-final-rec-bulletin.pdf. 
  2. Draft USPSTF aspirin recs for primary CVD prevention align with prior AHA guideline. News release. American Heart Association. Accessed October 13, 2021. https://newsroom.heart.org/news/draft-uspstf-aspirin-recs-for-primary-cvd-prevention-align-with-prior-aha-guideline.

This article originally appeared on MPR




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