Task Force recommends aspirin for primary prevention of CVD, colorectal cancer
The Task Force recommended that low-dose aspirin be initiated 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 U.S. Preventive Services Task Force recommended this week that aspirin be used for primary prevention of cardiovascular disease (CVD) and colorectal cancer.
The new recommendations update the Task Force's 2009 recommendation on aspirin use to prevent CVD events and its 2007 recommendation on aspirin and nonsteroidal anti-inflammatory drugs to prevent colorectal cancer. The Task Force reviewed research published since its last recommendations and also commissioned reviews of the benefits of aspirin for primary prevention of cardiovascular events, total and colorectal cancer incidence and mortality, and bleeding risk. Finally, it commissioned a decision analysis using simulation modeling to assess the expected net benefit of aspirin use across clinically relevant groups defined by their age, sex, and risk for CVD.
The recommendations and supporting evidence were published online April 12 by Annals of Internal Medicine.
Based on its review, the Task Force recommended that low-dose aspirin be initiated 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 (B recommendation; there is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial). Ten-year CVD risk was predicted by using a calculator derived from the American College of Cardiology/American Heart Association pooled cohort equations.
In adults ages 60 to 69 years who have a 10% or greater risk CVD risk, the Task Force recommended that the decision to initiate low-dose aspirin for primary prevention of CVD and colorectal cancer should be an individual one. Persons who are not at increased risk for bleeding, have a life expectancy of at least 10 years, and are willing to take a low-dose aspirin daily for at least 10 years are more likely to benefit. Those who place a higher value on potential benefits than potential harms may choose to initiate low-dose aspirin (C recommendation; there is at least moderate certainty that the net benefit is small).
The Task Force noted that current evidence is insufficient to assess the balance of benefits and harms of initiating aspirin use for the primary prevention of CVD and CRC in adults younger than age 50 years or ages 70 years and older (I statements; evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined).