Clinical Summary of U.S. Preventive Services Task Force Recommendation
This document is a summary of the 2009 recommendation of the U.S. Preventive Services Task Force (USPSTF) on aspirin for the prevention of cardiovascular disease. This summary is intended for use by primary care clinicians.
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| Population |
Men
Age 45-79 Years | Women
Age 55-79 Years
| Men
Age <45 Years | Women
Age <55 Years | Men & Women
Age ≥80 Years |
| Recommendation
| Encourage aspirin use when potential CVD benefit (MIs prevented)
outweighs potential harm of GI hemorrhage. | Encourage aspirin use when potential CVD benefit (strokes prevented) outweighs potential harm of GI hemorrhage. | Do not encourage aspirin use for MI prevention. | Do not encourage aspirin use for stroke prevention. | No Recommendation |
| Grade: A | Grade: D | Grade: I
(Insufficient Evidence)
|
| How to Use This Recommendation |
Shared decision making is strongly encouraged with individuals whose risk is close to (either above or below) the estimates of 10-year risk levels indicated below.
As the potential CVD benefit increases above harms, the recommendation to take aspirin should become stronger.
To determine whether the potential benefit of MIs prevented (men) and strokes prevented (women) outweighs the potential harm
of increased GI hemorrhage, both 10-year CVD risk and age must be considered.
Risk level at which CVD events prevented (benefit) exceeds GI harms
| Men |
Women |
| 10-year CHD risk |
10-year stroke risk |
| Age 45-59 years | ≥4% | Age 55-59 years | ≥3% |
| Age 60-69 years | ≥9% | Age 60-69 years | ≥8% |
| Age 70-79 years | ≥12% | Age 70-79 years | ≥11% |
The table above applies to adults who are not taking NSAIDs and who do not have upper GI pain or a history of GI ulcers.
NSAID use and history of GI ulcers raise the risk of serious GI bleeding considerably and should be considered in determining the balance of benefits and harms.
NSAID use combined with aspirin use approximately quadruples the risk of serious GI bleeding compared to the risk with aspirin use alone.
The rate of serious bleeding in aspirin users is approximately 2-3 times higher in patients with a history of GI ulcers.
|
| Risk Assessment |
For men: Risk factors for CHD include age, diabetes, total cholesterol level, HDL level, blood pressure, and smoking.
CHD risk estimation tool: http://healthlink.mcw.edu/article/923521437.html 
For women: Risk factors for ischemic stroke include age, high blood pressure, diabetes, smoking, history of CVD, atrial fibrillation, and left ventricular hypertrophy.
Stroke risk estimation tool: http://www.westernstroke.org/index.php?header_name=stroke_tools.gif&main=stroke_tools.php
|
| Relevant Recommendations from the USPSTF |
The USPSTF has made recommendations on screening for abdominal aortic aneurysm, carotid artery stenosis, coronary heart disease,
high blood pressure, lipid disorders, and peripheral arterial disease. These recommendations are available at
http://www.preventiveservices.ahrq.gov.
|
Abbreviations: CHD = coronary heart disease, CVD = cardiovascular disease,
GI = gastrointestinal, HDL = high-density lipoprotein, MI = myocardial infarction, NSAIDs = nonsteroidal anti-inflammatory drugs.
For the full recommendation statement and supporting documents, please go to: http://www.preventiveservices.ahrq.gov.
Disclaimer: Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.
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Copyright and Source Information
This document is in the public domain within the United States. For
information on reprinting, contact Randie Siegel, Associate Director, Office of Communications and Knowledge Transfer, Agency for Healthcare Research and Quality,
540 Gaither Road, Rockville, MD 20850.
Requests for linking or to incorporate content in electronic resources
should be sent to: info@ahrq.gov.
AHRQ Publication No. 09-05129-EF-3
Current as of March 2009
Internet Citation:
U.S. Preventive Services Task Force. Aspirin for the Prevention of Cardiovascular Disease: Clinical Summary. AHRQ Publication No.09-05129-EF-3, March 2009. Agency for Healthcare Research and Quality, Rockville, MD.
http://www.ahrq.gov/clinic/uspstf09/aspirincvd/aspcvdsum.htm
540 Gaither Road Rockville, MD 20850 