Should primary care clinicians recommend low-dose aspirin for the primary prevention of cardiovascular disease in adults 60 years or older?
In this updated review, the USPSTF recommends against initiating low-dose aspirin use (81 mg daily) for the primary prevention of CVD in adults 60 years or older (D recommendation). The task force recommends shared decision making regarding the initiation of low-dose aspirin for the primary prevention of CVD in adults 40 to 59 years with a 10% or greater risk of CVD and without an increased risk of bleeding (C recommendation). Risk factors for bleeding include older age, history of peptic ulcer disease, alcoholism, liver disease, long-term nonsteroidal anti-inflammatory drug or steroid use, and anticoagulant therapy. 1a
The US Preventive Services Task Force (USPSTF) found adequate evidence that low-dose aspirin used for the primary prevention cardiovascular disease (CVD) reduces the risk of major cardiovascular events. There is no high-quality evidence, however, that low-dose aspirin reduces the risk of cardiovascular mortality or all-cause mortality. Similarly, evidence remains uncertain of a benefit for reducing the risk of colorectal cancer. Potential harms include a significant risk of major bleeding events, with increasing risk proportional to increasing age. New recommendations (which replace the 2016 guidelines) include considering aspirin for high-risk individuals at age 40 years instead of 50 years, and no longer recommending aspirin for primary prevention in adults 60 years or older. For those patients already taking aspirin or choosing to start taking aspirin, the task force recommends stopping aspirin at approximately age 75 years. The American Heart Association recommends shared decision making regarding the use of aspirin for the primary prevention of CVD in high-risk adults aged 40 to 70 years who do not have an increased risk of bleeding.
David C. Slawson, MD
Professor and Vice Chair of Family Medicine for Education and Scholarship
Professor of Family Medicine, UNC Chapel Hill