Middle-aged and older adults shouldn’t be adding a dose of aspirin to their daily routine without consulting a doctor, according to guidance released this week by the U.S. Preventive Services Task Force Tuesday.
This new guidance replaces a 2016 recommendation to initiate a low-dose of aspirin to prevent cardiovascular disease and colorectal cancer in adults age 50 to 59 who had a 10% or greater cardiovascular disease risk, a life expectancy of at least 10 years and were not at risk for bleeding.
Cardiovascular disease causes one out of every four deaths in the U.S., making it the leading cause of death in the nation. An estimated 605,000 people in the U.S. experience their first heart attack every year and 610,000 people experience their first stroke. Aspirin is a blood thinner that can prevent clots from forming in the blood vessels leading to the heart or brain and is thus believed to reduce the risk of heart attacks and strokes.
Back in 2016, the USPSTF did not find sufficient evidence to recommend initiating aspirin use for the primary prevention of cardiovascular disease or colorectal cancer in adults younger than 50 years or older than 70. Now, the task force has determined “with moderate certainty” that aspirin use could have a small net benefit for adults age 40 to 59 who use it to prevent cardiovascular disease.
It also concluded that initiating aspirin use to prevent cardiovascular disease related incidents in people 60 years or older “has no net benefit.”
Older people are especially at risk for severe bleeding related to aspirin use, Chien-Wen Tseng, a professor in the Department of Family Medicine and Community Health at the University of Hawai’i John A. Burns School of Medicine and a member of the USPSTF task force, according to a report last year in The Washington Post.
People over 40 who have a higher risk of developing cardiovascular disease benefit more from daily aspirin, said the task force. For those who have started taking a daily dose of aspirin, benefits can accrue over time. However, those benefits become smaller with advancing age due to bleeding risks and the USPSTF said it may be “reasonable” to cease daily aspirin use around age 75.
“In addition to age and estimated level of [cardiovascular disease] risk, decisions about initiating aspirin use should be based on shared decision-making between clinicians and patients about the potential benefits and harms,” said the USPSTF.
To update the 2016 recommendation, the USPSTF “commissioned a systematic review on the effectiveness of aspirin” to reduce cardiovascular disease-related events such as heart attacks and strokes. It also “commissioned a microsimulation modeling study to assess the net balance of benefits and harms from aspirin use.”
According to the task force further research is still needed in some areas, including: cardiovascular disease risk prediction in all racial and ethnic and socioeconomic groups, the gastrointestinal bleeding risk associated with aspirin use in the primary U.S. cardiovascular disease prevention population, information about patient preferences and the effects of low-dose aspirin use on colorectal cancer incidence and mortality over the long term.
As of the new recommendation publication date, the American College of Cardiology and American Heart Association recommended that low-dose aspirin might be considered for the primary prevention of atherosclerotic cardiovascular disease among select adults aged 40 to 70 years. The American Academy of Family Physicians also supported the 2016 USPSTF recommendation on aspirin use.
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