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USPSTF Advises Against Starting Aspirin in ≥60s to Prevent CVD

For adults aged 40 to 59 years with 10 percent or greater 10-year CVD risk, decision to initiate aspirin should be individualized

TUESDAY, Oct. 12, 2021 (HealthDay News) — The U.S. Preventive Services Task Force (USPSTF) recommends against initiating use of aspirin for the primary prevention of cardiovascular disease (CVD) for adults aged 60 years or older, while for adults aged 40 to 59 years, the decision to initiate aspirin should be individualized. These findings form the basis of a draft recommendation statement published online Oct. 12 by the USPSTF.

Janelle M. Guirguis-Blake, M.D., from the Kaiser Permanente Evidence-based Practice Center in Portland, Oregon, and colleagues conducted a systematic review of the literature and performed a meta-analyses of the data from 13 fair-to-good-quality randomized controlled trials, with a total of 161,680 participants, to examine the effectiveness of aspirin for the primary prevention of CVD. The researchers found that low-dose aspirin reduced the risk for major CVD events, myocardial infarction, and ischemic stroke (Peto odds ratios, 0.90, 0.89, and 0.82, respectively), with no differences seen for CVD mortality or all-cause mortality, based on a pooled analysis of 11 trials. In the trials, the absolute risk reductions in major CVD events ranged from 0.08 to 2.5 percent. Low-dose aspirin was associated with an increased risk for intracranial bleeding events and extracranial bleeding events (Peto odds ratios, 1.31 and 1.53, respectively). The absolute risk increases ranged from −0.2 to 0.4 percent and 0.2 to 0.9 percent for intracranial and extracranial bleeding events, respectively.

Based on these findings, the USPSTF concluded that in adults ages 40 to 59 years with a 10 percent or greater 10-year CVD risk, the decision to initiate low-dose aspirin for the primary prevention of CVD should be individualized (C recommendation); the net benefit of aspirin use is small in this group. For adults aged 60 years or older, the initiation of low-dose aspirin use is not recommended for the primary prevention of CVD (D recommendation).

The draft recommendation statement, evidence review, and technical report have been posted for public comment. Comments can be submitted from Oct. 12 to Nov. 8, 2021.

Draft Evidence Review

Draft Technical Report

Draft Recommendation Statement

Comment on Recommendation Statement

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