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USPSTF 2022 recommends against initiating aspirin for primary prevention of cardiovascular disease in adults 60+ years (D recommendation)
Clinical Question
Should primary care clinicians recommend low-dose aspirin for the primary prevention of cardiovascular disease in adults 60 years or older?
Bottom line
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
Reference
Study design: Practice guideline
Funding: Government
Setting: Population-based
Synopsis
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.
Reviewer
David C. Slawson, MD
Professor and Vice Chair of Family Medicine for Education and Scholarship
Atrium Health
Professor of Family Medicine, UNC Chapel Hill
Charlotte, NC
Comments
Low dose aspirin in adults over 60 to refuse CV RISK
its well received that low dose aspirin reduces the risk of coronary arterial acute event in adults over 60.taking in to consideration of the risks like gastro duodenal ulcer bleed in a small percentage,the benefits of aspirin preventing coronary obstruction . we can also appreciate the collateral benefits of preventing thrombotic cerebro vascular accident.
USPSTF 2022 recommends against initiating aspirin for primar
I wish that the USPSTF had looked at the risk/benefit ratio of use of ECASA in primary prevention in a patient with >20% 10 year risk of angina/MI. This would have been more helpful.
asa in primary prevention for cad
not indicated