U.S. Preventive Services Task Force. Aspirin for the prevention of cardiovascular disease: U.S. Preventive Services Task Force recommendation statement

Overview

This article describes new 2009 recommendations for the use of aspirin in the primary prevention of heart disease among those who have never had a heart attack or stroke. The purpose of these guidelines is to provide advice to doctors and patients about who should and should not take aspirin. The U.S. Preventive Services Task Force (USPSTF) found that aspirin should be used when its benefits outweigh its harms. These new guidelines update previous guidelines published in 2002 and define the different levels of risk required to consider aspirin use for different age groups.

Methodology

The USPSTF developed these federal guidelines based on a thorough analysis of existing information from scientific studies. These new guidelines update previous guidelines published in 2002. The methods used to develop this evidence are described in an article by Wolff, et al (2009) that accompanied the guideline publication (see: Updated evidence for the 2009 U.S. Preventive Services Task Force aspirin recommendations).

Results

  • To determine whether benefits outweigh harms, the USPSTF recommends using risk scoring systems to determine the ten-year risk of having a heart attack (for men) or a stroke (for women).

  • They recommend a Framingham-based risk scoring system for heart attack risk in men based on patient age, smoking status, diabetes status, systolic blood pressure and cholesterol levels (both total cholesterol and HDL-cholesterol).

  • For women they recommend a risk-scoring system for projected 10-year stroke risk based on patient age, smoking status, systolic blood pressure, blood pressure medication status, atrial fibrillation status, the presence of diabetes and heart enlargement.

  • Men should take aspirin if their risk of a heart attack is 4% or more for ages 45-59 years, 9% for ages 60-69 and 12% for ages 70-79.

  • Women should take aspirin if their risk of a stroke is 3% or more for ages 55-59 years, 8% for ages 60-69, and 11% for ages 70-79.

Conclusions

  • Aspirin should be used when its benefits outweigh its harms. These new guidelines update previous guidelines published in 2002. In their previous aspirin guidelines, the USPSTF recommended that all persons whose projected 10-year risk of a cardiovascular disease event was 10% or more take aspirin. In these new guidelines, this is refined so that different levels of risk are required for different age groups.

  • Overall USPSTF guideline recommendations:

    • Men age 45 to 79 years take aspirin when the likely benefit of reduced heart attacks outweighs the increased risk of gastrointestinal hemorrhage.

    • Women age 55 to 79 years take aspirin when the benefit of reduced ischemic strokes outweighs the increased risk of gastrointestinal hemorrhage.

    • Do not use aspirin for cardiovascular disease prevention in women younger than 55 years and in men younger than 45 years.

    • There is not enough evidence to assess the balance of benefits and harms in men and women 80 years or older.

  • Revision of these recommendations is underway and new recommendations will be published in 2015.