Forward Guidance on Aspirin for Prevention
Read this section about policy work of the Council on Aspirin for Health and Prevention and other organizations aimed at improving aspirin use through these initiatives and programs.
Cardiovascular disease, cancer and type 2 diabetes cause 70% of U.S. deaths and account for nearly 75% of health care expenditures. Partnership for Prevention believes the best way to combat chronic disease is by preventing it in the first place.1
When it comes to cardiovascular disease—the leading cause of death in the United States—45,000 lives could be saved each year if 90% of people at risk for heart attack or stroke took aspirin daily.2×
Analysis of the 2016 USPSTF Recommendation
The Council on Aspirin advises to:
- Initiate aspirin in men and women 50 to 69 who are at higher risk of cardiovascular disease and low risk for excessive bleeding.
- Consider starting aspirin for those younger than 50 years who have very high risk of cardiovascular disease.
- Starting aspirin may be reasonable in some 70- to 79-year-olds who prefer this option and have high cardiovascular disease risk.
- The new recommendations support continuing aspirin past the age of 70 years if it was started at a younger age.
- Start or continue aspirin at a daily dose of 81 mg.
USPSTF 2016 Recommendation on Aspirin Use
USPSTF 2016 Recommendation on Aspirin Use to Prevent Cardiovascular Disease and Colorectal Cancer
In April 2016, the United States Preventive Services Task Force (USPSTF) published a final recommendation statement on aspirin use for the primary prevention of cardiovascular disease and colorectal cancer. In addition, the evidence summaries were released which outline the studies reviewed to produce the recommendation. The Task Force found that people ages 50 to 59 who have an increased risk for cardiovascular disease can lower their risk for heart attacks, stroke and colon cancer by taking a daily low-dose aspirin. They also found that those ages 60 to 69 can benefit as well but should discuss the treatment with their health care provider first. Access the recommendation summary. A consumer fact sheet (PDF) explains the final recommendation in plain language.
Public Comment to the USPSTF
Council on Aspirin’s Public Comment to the USPSTF
In October 2015, the Council on Aspirin for Health and Prevention submitted a public comment to the United States Preventive Services Task Force (USPSTF) on the draft recommendation statement and draft evidence summaries related to aspirin for the prevention of cardiovascular disease and cancer. It agreed with the conclusion of the USPSTF that aspirin, when used appropriately, is useful to prevent a first heart attack or stroke in both men and women. The Council also applauded the Task Force for adding colorectal cancer to the aspirin recommendation, the first time a major U.S. medical organization has issued a recommendation to take aspirin to prevent a form of cancer. Some changes to the draft recommendation were also suggested, including the need for further guidance from the USPSTF for several age and risk groups.
Response to the FDA
FDA's Rejection of Aspirin Use for Primary Prevention
The Food and Drug Administration (FDA) recently declined Bayer HealthCare’s petition to allow aspirin to be approved for the primary prevention of heart attack and stroke among those at moderate risk for heart disease (i.e., with a 10-year risk of ≥10%). The FDA reviewed the scientific evidence to weigh the benefits of taking aspirin against the risks associated with it and determined that there was insufficient evidence to warrant the use of aspirin for primary prevention, even among higher-risk individuals. Partnership for Prevention and its Council on Aspirin for Health and Prevention (CAHP) respect the FDA’s process and interpretation of the evidence for making regulatory decisions, but believe the benefits of taking aspirin outweigh the risk for bleeding in many people at moderate to high-risk for a first heart attack or stroke.
Aspirin Advice and Medicare
Learn how Medicare covers provider–patient discussion of aspirin use
In 2010, Partnership for Prevention and the Council on Aspirin for Health and Prevention submitted a National Coverage Determination request to the Centers for Medicare & Medicaid Services (CMS) asking that health care providers be reimbursed for talking to patients about taking aspirin to prevent heart attack and stroke. Council on Aspirin for Health and Prevention (Council) members Drs. Randall Stafford and Jason Spangler, as well as Dr. Veronica Yank from Stanford University, were involved in this effort. CMS reviewed the request and evidence behind aspirin counseling, and agreed. In 2011, they created the intensive behavioral counseling for cardiovascular disease benefit to reimburse providers for:
- Encouraging aspirin use for the primary prevention of cardiovascular disease in men ages 45-79 and women ages 55-79 when the benefits outweigh the harms
- Screening for high blood pressure in adults (18 and older)
- Counseling to promote a healthy diet for adults with risk factors for heart disease or diet-related chronic diseases
Now individuals enrolled in Medicare (Parts A and B) may see their health care provider once a year to receive this intensive counseling. Partnership for Prevention received the 2011 Health Policy Award by the National Forum for Heart Disease and Stroke Prevention for this work.
Aspirin Use as a Quality Measure
Understand how HEDIS promotes aspirin use
Because aspirin is known to prevent heart attacks and strokes, but is under-utilized by many who could benefit from it, Partnership for Prevention and the Council worked with the National Committee for Quality Assurance (NCQA) to develop an aspirin quality measure for health plans. Council members Dr. Michael Pignone, Dr. Randall Stafford, and Kathy Berra served as experts during this process.
The measure was added to the Healthcare Effectiveness Data and Information Set (HEDIS) in 2010. HEDIS is a tool used by 90% of health plans to measure their performance. Quality measures, such as those in HEDIS, can encourage providers to deliver important health services and meet other goals for improving the quality of health care in the United States.
The aspirin quality measure includes two parts: 1) Aspirin Use and 2) Discussing Aspirin Risks and Benefits. Through a patient survey, it measures the fraction of men aged 46-79 and women aged 56-79 enrolled in managed care plans who have discussed the benefits and harms of aspirin with their health care provider. Collection of these data can tell us how physicians are doing and provide consumers with a way to compare their health care plan choices.
Aspirin Counseling as a National Priority
See how aspirin counseling compares to other clinical preventive services in importance
In 2006, the National Commission on Prevention Priorities (NCPP) released a ranking of clinical preventive services that showed discussing daily aspirin use to be one of the highest-value services a clinician can provide. The ranking lists 25 clinical preventive services recommended by the U.S. Preventive Services Task Force in order from highest value to lowest. Each service’s position is determined by the sum of two scores: one for health impact and one for cost-effectiveness. Discussing daily aspirin scored a 10, the highest possible. The NCPP is updating the ranking and a new version is expected to be released in early 2014. Read the 2006 NCPP Rankings.
Aspirin Counseling, Part of the ABCS
Saving a Million Hearts via Aspirin, Blood pressure control, Cholesterol reduction and Smoking cessation
The “ABCS” is an easy way to remember four effective methods for preventing heart attack and stroke: take Aspirin, control Blood pressure and Cholesterol, and quit Smoking. The Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) have teamed up to lead the Million Hearts initiative, a national program whose mission is to prevent a million heart attacks and strokes by 2017 using the ABCS as its guiding principle. These two Federal health agencies are working with other federal agencies and many private partners, including Partnership for Prevention, to meet this goal by scaling up strategies known to work in clinics and in communities. While it is clear that aspirin prevents second heart attacks, its use for preventing first heart attacks and strokes has not been so widely put into practice. This site can play an important role in the Million Hearts initiative by informing and providing direction to consumers and health care providers on aspirin’s role in preventing first heart attacks and strokes.
New and Improved Guidelines
Find out more about the upcoming clinical practice guidelines from the American Heart Association and American College of Cardiology
The American Heart Association and American College of Cardiology are developing and communicating new clinical practice guidelines about heart disease and stroke prevention. These will include guidelines for aspirin. This process will build on the work of the National Heart, Lung, and Blood Institute (NHLBI) in systematically reviewing the scientific evidence on this broad topic. Five systematic reviews that examine the scientific evidence for cardiovascular disease topics have been completed for High Blood Pressure, Cholesterol, Obesity, Lifestyle Interventions, and Risk Assessment. These reviews provide the foundation for the upcoming clinical guidelines. Council member Dr. Karol Watson is a member of the expert panel on Cholesterol. To learn more about this new and collaborative approach, read about it at the journal Circulation: Refocusing the Agenda on Cardiovascular Guidelines: An Announcement from the National Heart, Lung, and Blood Institute.
Recommendations for Aspirin Built on Evidence
Learn more about future aspirin recommendations from the USPSTF
The U.S. Preventive Services Task Force (USPSTF) is currently reviewing the scientific evidence regarding preventive aspirin use to update its aspirin recommendations. In 2015, two new recommendations for aspirin use will be published. These integrated recommendations will be for:
- Aspirin Use for the Primary Prevention of Cardiovascular Events
- Aspirin Use for the Primary Prevention of Cancer
The USPSTF will first publish draft recommendation statements that will be open for public comment. After the public comment period closes, the USPSTF will review those comments and consider whether to revise these statements. Final recommendations are then published.
Expanded Insurance Coverage for Prevention Services
Learn more about the Affordable Care Act’s requirement to cover prevention
The Patient Protection and Affordable Care Act of 2010 (ACA) requires that private insurance plans provide preventive services if they are recommended by the USPSTF. These services are to be provided without patient cost-sharing (i.e., without copayments or deductibles). Section 2713 of this federal law took effect in August 2012 for new health plans and will eventually cover all health plans. This is one of several parts of the Affordable Care Act aimed at strengthening the role of prevention. Learn more about the benefits listed under the ACA.