Aspirin prevents CVD and colorectal cancer: USPSTF Recommendation Statement

To update the 2009 U.S. Preventive Services Task Force (USPSTF) recommendations on aspirin use to prevent cardiovascular disease (CVD) events and the 2007 recommendation on aspirin and non-steroidal anti-inflammatory drug use to prevent colorectal cancer (CRC), the USPSTF reviewed 5 additional primary prevention trials of aspirin, mostly in individuals at low risk for CVD; multiple analyses of CRC follow-up data; and a comprehensive review of the potential harms of aspirin use.

The recommendations below apply to adults ≥ 40 years of age without known CVD or increased bleeding risk.

The USPSTF now recommends:

· Initiating low-dose aspirin use for the primary prevention of CVD and CRC in adults aged 50 to 59 years who have a 10% or greater 10-year CVD risk, are not at increased risk for bleeding, have a life expectancy of at least 10 years, and are willing to take low-dose aspirin daily for at least 10 years. (B recommendation)

· The decision to initiate low-dose aspirin use for the primary prevention of CVD and CRC in adults aged 60 to 69 years who have a 10% or greater 10-year CVD risk should be an individual one. Persons who are not at increased risk for bleeding, have a life expectancy of at least 10 years, and are willing to take low-dose aspirin daily for at least 10 years are more likely to benefit. Persons who place a higher value on the potential benefits than the potential harms may choose to initiate low-dose aspirin. (C recommendation)

· The current evidence is insufficient to assess the balance of benefits and harms of initiating aspirin use for the primary prevention of CVD and CRC in adults younger than 50 years.

· The current evidence is insufficient to assess the balance of benefits and harms of initiating aspirin use for the primary prevention of CVD and CRC in adults aged 70 years or older.

REFERENCES

· 1Bibbins-Domingo K, on behalf of the U.S. Preventive Services Task Force. Aspirin use for primary prevention of cardiovascular disease and colorectal cancer: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2016; 164: 836-45.

· 2Baigent C. Aspirin for disease prevention: Public policy or personal choice? Ann Intern Med. 2016; 164: 846-7.