New US Preventive Services Task Force recommendations on aspirin chemoprophylaxis

doi:10.1136/bmjusa.02030002

BMJ, doi: 10.1136/bmjusa.02030002, (Published 28 August 2002)

Editorials

New US Preventive Services Task Force recommendations on aspirin chemoprophylaxis

This article originally appeared in BMJ USA

In January 2002, the US Preventive Services Task Force (USPSTF) updated its recommendations on the use of aspirin for theprimary 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 reviewfound good evidence that aspirin decreases the incidence of coronaryheart disease in high-risk adults, good evidence that aspirinincreases the incidence of gastrointestinal bleeding, and fairevidence that aspirin increases the incidence of hemorrhagic strokes.The USPSTF gave an A recommendation to discussing these benefitsand harms with all adults at increased risk of coronary heartdisease: men older than 40 years, postmenopausal women, and youngerpeople with risk factors such as hypertension, diabetes, or smoking.The panel indicated that the balance of benefits and harms fromlong-term aspirin use is most favorable in high-risk groups (>3%risk of developing heart disease within 5 years), but noted thatthe tradeoffs are subject to patient preferences and that somepeople at lower risk may not find the balance of benefits andharms acceptable. It referred clinicians to resources to calculate5-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 therapyevery 5 years was a "reasonable option." Although older patientsmay derive greater benefits because they are at higher risk forCHD and stroke, their risk for bleeding may also behigher.

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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