Panel Backs Away from Aspirin for Cardiovascular Disease Primary Prevention

By Jonathan Springston, Editor, Relias Media

The U.S. Preventive Services Task Force (USPSTF) updated recommendations regarding aspirin as a prevention tool against stroke, heart attack, and cardiovascular disease (CVD).

Patients age 40 to 59 years who are at higher risk for CVD (but who do not have a history of CVD) should make the decision as individuals with their healthcare providers. For patients age 60 years and older, the USPSTF recommends against starting aspirin to protect against CVD.

“We want to emphasize that these recommendations are focused on starting aspirin to prevent a first heart attack or stroke. Anyone who already takes aspirin and has questions about it should speak with their healthcare professional,” USPSTF member John Wong, MD, said in a statement.

The USPSTF first floated the idea of aspirin as a CVD prevention tool more than 30 years ago. Since then, the panel has updated these guidelines several times. After the 2016 update, there were three key trials published in 2018. These three studies were part of 11 randomized trials USPSTF reviewed to make the latest recommendations.

“Compared with older trials, these [2018] trials were performed in more contemporary populations with likely better control of blood pressure and lipids and a lower prevalence of smoking. Taken together, these more recent trials cast doubt about net benefit for aspirin prophylaxis in current practice,” the authors of an editorial accompanying the USPSTF recommendation wrote.

The American College of Cardiology (ACC) observed the latest USPSTF statement “generally aligns” with recommendations the ACC/American Heart Association issued in 2019. At that time, those groups concluded “aspirin should be used infrequently in the routine primary prevention” of CVD.

There will be much more on this news in an Abstract & Commentary article set to appear in an upcoming issue of Internal Medicine Alert. Click here to read all the latest articles from that newsletter.

For even more on this and related subjects, be sure to read the latest issues of Clinical Cardiology Alert.