Aspirin guidelines push stroke prevention

Incorporating findings that men and women respond differently to prophylactic aspirin therapy, the U.S. Preventive Services Task Force (USPSTF) has updated its guidelines.

New recommendations call for at-risk men aged 45-79 years to take aspirin daily to prevent a primary heart attack, unless the likelihood of GI bleeding outweighs the potential protection. Similarly, at-risk women aged 55-79 years should take aspirin to prevent a primary ischemic stroke, unless the odds of bleeding are too great (Ann Intern Med. 2009;150:396-404, accessed May 8, 2009).

USPSTF reviewed evidence published since its last report in 2002. In addition to the gender difference, the effectiveness of aspirin therapy was found to increase with the number of risk factors a patient presents for cardiovascular disease.

Meanwhile, Swiss researchers have pegged <81 mg as the optimal daily aspirin dose for efficacy and safety. “Doses >100 mg are not associated with clear benefit and may cause harm,” they write (Ann Intern Med. 2009;150:379-386).

Both reports focus on primary coronary prevention, but new analysis of unrelated CDC data found that primary-care providers need to put more focus on secondary stroke prevention too.

“Alarmingly high numbers of adults did not receive secondary stroke prevention services,” researchers report. “Even though 90% of adults in our study had health insurance coverage, and 90% identified at least one health-care provider, use of accepted, guideline-recommended care was suboptimal” (Stroke. 2009;40:1811-1819, subscription required).

Results varied widely:
CV risk reduction: 31% received outpatient rehabilitation services; 77% used aspirin regularly; 81% reported annual cholesterol measurement; 66% received smoking cessation counseling; and 57% reported exercising regularly.

Hypertension management: 62% of those diagnosed received low-fat and 74% received low-salt diet counseling; 91% took antihypertensive medication regularly.

Diabetes management: 89% of diagnosed patients reported annual hemoglobin A1c assessments.

Infectious disease prevention: 52% reported having flu shots; 53% reported pneumococcal vaccination.

Lead author Joseph S. Ross, MD, MHS, Mount Sinai School of Medicine, in New York City, suggests that clinicians focus first on getting patients to exercise. “This straightforward stroke-prevention strategy needs to be prioritized by primary-care clinicians and neurologists,” Dr. Ross urges.
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