SUMMARY:

The 2022 USPSTF recommendations, based on the most current literature, provide updated guidance regarding the use of aspirin to reduce risk for cardiovascular disease (CVD). CVD is responsible for approximately 25% of deaths in the US and is currently the leading cause of mortality.

Research Plan

Systematic Review

• Evaluation of CVD risks
  • Effectiveness of aspirin to reduce the risk of CVD events (myocardial infarction and stroke) | Cardiovascular mortality | All-cause mortality in persons without a history of CVD
• Harms: Primary focus on bleeding
  • GI bleeding | Intracranial hemorrhage | Hemorrhagic stroke

Population

• Adults ≥40 years
• No signs or symptoms of CVD or known CVD (including history of myocardial infarction or stroke)
• Not at increased risk for bleeding

Recommendations 

Ages 40 to 59 years and ≥10-year CVD Risk

• Decision to initiate low-dose aspirin use for the primary prevention of CVD should be an individual one
  • Evidence indicates that the net benefit of aspirin use in this group is small
  • Persons who are not at increased risk for bleeding and are willing to take low-dose aspirin daily are more likely to benefit
• C recommendation
  • The USPSTF recommends selectively offering or providing this service to individual patients based on professional judgment and patient preferences
  • There is at least moderate certainty that the net benefit is small
  • Offer or provide this service for selected patients depending on individual circumstances

≥60 years

• The USPSTF recommends against initiating low-dose aspirin use for the primary prevention of CVD
• D recommendation
  • The USPSTF recommends against the service
  • There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits
  • Discourage the use of this service

KEY POINTS:

• CVD risk assessment tool
  • The American College of Cardiology/American Heart Association (ACC/AHA) Pooled Cohort Equations
  • May be used to estimate 10-year risk of CVD | Only validated US-based CVD risk prediction tool | Age is a main driver of risk for CVD
  • Risks using the ACC/AHA tool are only estimates
• Bleeding risk is increased with the following
  • Increasing age | Male sex | Diabetes | GI history (e.g., peptic ulcer disease) | Liver disease | Smoking | Elevated BP | Certain medications (e.g., NSAIDs)
• Recommendations of Others (see ‘Learn More – Primary Sources’)
  • The ACC/AHA recommends that low-dose aspirin use (75 to 100 mg/d) might be considered for the primary prevention of atherosclerotic CVD among select adults aged 40 to 70 years at higher CVD risk but not at increased risk of bleeding
  • Low-dose aspirin use is not recommended on a routine basis for primary prevention of CVD in adults >70 years or among adults of any age who are at increased risk of bleeding
• Aspirin dose
  • Benefits of aspirin for CVD prevention appear similar for a low dose (≤100 mg/d) and for all doses that have been studied in CVD prevention trials (50 to 500 mg/d)
  • The USPSTF states that “A pragmatic approach would be to use 81 mg/d, which is the most commonly prescribed dose in the US”

Learn More – Primary Sources:

Aspirin Use to Prevent Cardiovascular Disease: US Preventive Services Task Force Recommendation Statement