BMJ  2003;327:E99 (4 October), doi:10.1136/bmjusa.02030002 (published 28 August 2002)

BMJ USA: Editorial

New US Preventive Services Task Force recommendations on aspirin chemoprophylaxis

In January 2002, the US Preventive Services Task Force (USPSTF) updated its recommendations on the use of aspirin for the primary prevention of cardiovascular disease (http://www.ahrq.gov/clinic/3rduspstf/aspirin/asprr.htm). The recommendations were based on a commissioned evidence review, published in the Annals of Internal Medicine.¹ That review found good evidence that aspirin decreases the incidence of coronary heart disease in high-risk adults, good evidence that aspirin increases the incidence of gastrointestinal bleeding, and fair evidence that aspirin increases the incidence of hemorrhagic strokes. The USPSTF gave an A recommendation to discussing these benefits and harms with all adults at increased risk of coronary heart disease: men older than 40 years, postmenopausal women, and younger people with risk factors such as hypertension, diabetes, or smoking. The panel indicated that the balance of benefits and harms from long-term aspirin use is most favorable in high-risk groups (>3% risk of developing heart disease within 5 years), but noted that the tradeoffs are subject to patient preferences and that some people at lower risk may not find the balance of benefits and harms acceptable. It referred clinicians to resources to calculate 5-years risks in patients (http://www.intmed.mcw.edu/clincalc/heartrisk.html). Doses of 75 mg per day appear to be as effective as higher doses. The report said that repeating discussions of aspirin therapy every 5 years was a "reasonable option." Although older patients may derive greater benefits because they are at higher risk for CHD and stroke, their risk for bleeding may also be higher.

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This article originally appeared in BMJ USA

References

1. US Preventive Services Task Force. Aspirin for the Primary Prevention of Cardiovascular Events: Summary of the Evidence. Ann Intern Med 2002;1362:161-172

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