USPSTF pulls back on recommendation of low-dose aspirin for primary prevention

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social@drbretsky.com

The U.S. Preventive Services Task Force (USPSTF) is revising its recommendation on preventive aspirin to support its use for fewer patients.

In the new draft recommendation, the USPSTF recommends that the decision to begin low-dose aspirin use for the primary prevention of cardiovascular disease (CVD) in adults ages 40 to 59 years who have a 10% or greater 10-year CVD risk be an individual one (Grade C, small net benefit). The Task Force also recommends against starting low-dose aspirin for the primary prevention of CVD in adults ages 60 years or older (Grade D, no net benefit).

Based on new analyses of the evidence from primary CVD prevention populations, longer-term follow-up data from the Women’s Health Study, and new trial evidence, the USPSTF also concluded that the evidence is inadequate that low-dose aspirin use reduces colorectal cancer incidence or mortality.

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More research is needed to evaluate gastrointestinal bleeding risk associated with aspirin use in CVD prevention, improve the accuracy of CVD risk prediction, understand patient preferences for CVD risk in informed decision making, and observe effects of low-dose aspirin on colorectal cancer incidence and mortality over the long term, according to the draft.

Public comments can be made through Nov. 8. When final, this recommendation will replace the 2016 USPSTF recommendation, which recommended initiating low-dose aspirin use for the primary prevention of CVD and colorectal cancer in adults ages 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. The 2016 recommendation said that the decision to initiate low-dose aspirin use in adults ages 60 to 69 years who have a 10% or greater 10-year CVD risk should be an individual one. 

CTTO: https://acpinternist.org/weekly/archives/2021/10/19/5.htm

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