The U.S. Preventive Services Task Force (USPSTF) has issued a draft recommendation statement on aspirin use for cardiovascular disease prevention. The new recommendations are designed to update earlier guidance from 2016, given new evidence.

Specifically, the USPSTF recommends that people ages 40 to 59 who are at higher risk for cardiovascular disease, who do not have a history of cardiovascular disease, and who are not already taking aspirin decide with their clinician whether to start taking aspirin. The Task Force also recommends against people ages 60 or older starting to take aspirin for heart disease and stroke prevention, given the bleeding risks.

“Daily aspirin use may help prevent heart attacks and strokes in some people, but it can also cause potentially serious harms, such as internal bleeding,” says USPSTF member John Wong, MD. “It’s important that people who are 40 to 59 years old and don’t have a history of heart disease have a conversation with their clinician to decide together if starting to take aspirin is right for them.”

The Task Force’s draft recommendation statement, draft evidence review and draft modeling report have been posted for public comment through Nov. 8 on the USPSTF website.

The ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease also addresses aspirin use. Key highlights from the guideline related to aspirin include:

• Low-dose aspirin might be considered for primary prevention of atherosclerotic cardiovascular disease (ASCVD) in select higher-risk adults ages 40 to 70 years who are not at increased risk of bleeding.
• Low-dose aspirin should not be administered on a routine basis for primary prevention of ASCVD among adults younger than 70 years.
• Low-dose aspirin should not be administered for primary prevention among adults at any age who are at increased bleeding risk.

Amit Khera, MD, FACC, director of the Preventive Cardiology Program at the University of Texas Southwestern Medical Center, who served on the writing committee for the 2019 guideline, said in the Washington Post that he hopes clinicians will be “more judicious” in recommending aspirin. “Many people think of aspirin almost like a vitamin and that it’s benign, but that’s not true. When we talk about major bleeding, we’re talking about bleeding in the brain, bleeding that needs transfusions, so not like nosebleed-type stuff."

Clinical Topics: Prevention

Keywords: Stroke, Hemorrhage, Myocardial Infarction, Primary Prevention, Cardiovascular Diseases, Aspirin

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