ASPIRIN NOW OK FOR PRIMARY PREVENTION!

Two years ago, the United States Preventive Services Task Force (USPSTF), the agency of record for preventive health care recommendations, stated that “low risk people age 40-70 SHOULD NOT take aspirin for primary prevention of cardiovascular disease (CVD).” Additionally, they stated that people in the same age group, who have a higher 10-year risk of CVD, should also NOT take aspirin for primary prevention because the risk of GI bleeding outweighs the benefit of protection against CVD. 

Now, two years later, three articles appeared in the same issue of JAMA that change that recommendation. The results of multiple studies (11 randomized controlled trials) were compiled, analyzed, and the following conclusions reported:

Low dose aspirin (<100mg/day) was associated with a significant decrease in major cardiovascular disease events. (Aspirin helps in primary prevention)

Several population groups may benefit from taking aspirin for primary prevention of CVD, primarily in persons starting at younger ages with higher 10-year CVD risk. 

Aspirin WAS NOT significantly associated with a significant decrease in cardiovascular disease mortality or all-cause mortality. (Aspirin prevents CVD but not death)

The USPSTF with “moderate certainty” concludes that for people age 40-59 years, low dose aspirin has “a small net benefit” in those folks with a 10% or greater 10-year risk of CVD. 

The USPSTF with “moderate certainty” concludes that “aspirin for primary prevention of CVD events in adults 60 years or older has no net benefit.”

** So if you’re over 40 yet under 60, and have risk factors for heart disease, low dose aspirin is for you. Start early and continue long.

** If you’re 60 years or older, the use of aspirin for primary prevention is NOT RECOMMENDED. 

That sums it up! 

** Under age 60, take aspirin if you’re diabetic, a smoker, have high blood pressure, or have a bad family history. 

** Above age 60 you’re risk of GI bleeding is greater than the benefit of taking aspirin. Low-dose aspirin is NOT recommended.

References: US Preventive Services Task Force. Aspirin use to prevent cardiovascular disease. JAMA 2022 April 26;327(16):1577-1584.

Guirguis-Blake JM, et al. Aspirin Use to Prevent Cardiovascular Disease and Colorectal Cancer. JAMA 2022 Apr 26;327(16):1585-1595.

Dehmer SP, et al. Aspirin Use to prevent cardiovascular disease and colorectal cancer. JAMA 2022 Apr 26;327(16):1598-1607.

JAMA Patient Page: Use of Aspirin to Prevent Cardiovascular disease. JAMA 2022 Apr 26;327(16):1642.