The U.S. Preventive Services Task Force (USPSTF) recommends initiation of low-dose aspirin therapy to prevent cardiovascular disease (CVD) and colorectal cancer in adults aged 50 to 59 years, as reported in the Annals of Internal Medicine.
The USPSTF gave this recommendation a B rating, noting that an aspirin regimen should be initiated in adults who have a 10% or greater 10-year CVD risk, a life expectancy of at least 10 years, and are not at an increased risk for bleeding. The decision to initiate aspirin therapy in adults between 60 and 69 years of age should be made on an individual basis.
Kirsten Bibbins-Domingo, PhD, MD, MAS, professor of medicine and of epidemiology and biostatistics at the University of California, San Francisco, authored the report on behalf of the USPSTF. Dr Bibbins-Domingo noted that potential benefits of aspirin use are prevention of myocardial infarction, stroke, and reduced instances of colorectal cancer, when used long-term. Correlating small-to-moderate harms include possible gastrointestinal bleeding and hemorrhagic stroke. However, the USPSTF has concluded “with moderate certainty that the benefit of aspirin use for the primary prevention of CVD events, combined with the reduced incidence of colorectal cancer, outweighs the increased risk for bleeding by a moderate amount.”
Before instituting an aspirin regimen, clinicians are advised to perform baseline assessments to determine a patient’s risk for CVD. Risk assessment should include notation of a patient’s age, sex, and ethnicity, as well as total and HDL cholesterol levels, systolic blood pressure, and history of hypertension treatment, diabetes, and smoking. Male sex and old age are considered risk factors for potential GI bleeding.
“The decision about the level of CVD risk at which the potential benefits outweigh the potential harms is an individual one,” wrote Dr Bibbins-Domingo. “Some adults may decide that avoiding an MI or stroke is very important and that having a GI bleeding event is not as significant.”
“Adults who have a high likelihood of benefit with little potential harm should be encouraged to consider aspirin use. Conversely, adults who have little potential benefit or high risk for GI bleeding should be discouraged from it,” Dr Bibbins-Domingo concluded.
- Bibbins-Domingo K. Aspirin use for the primary prevention of cardiovascular disease and colorectal cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2016;164; doi: 10.7326/M16-0577