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Task Force recommends using aspirin to prevent cardiovascular disease when the benefits outweigh the harms

Patients and clinicians should consider risk factors such as age, sex, diabetes, blood pressure, cholesterol levels, smoking, and risk of gastrointestinal bleeding before deciding whether to use aspirin to prevent heart attacks or strokes, according to new recommendations from the U.S. Preventive Services Task Force. These recommendations do not apply to people who have already had a heart attack or stroke. Cardiovascular disease is the leading cause of death in the United States. It is the underlying or contributing cause in approximately 58 percent of all deaths.

The Task Force reviewed new evidence from the National Institutes of Health's Women's Health Study published since the last Task Force review of this topic in 2002, including a recent meta-analysis of the risks and benefits of aspirin. They found aspirin may have different benefits and harms in men and women. The Task Force found good evidence that aspirin decreases first heart attacks in men and first strokes in women. In 2002, the Task Force strongly recommended that clinicians discuss aspirin use with adults at increased risk for coronary heart disease and that discussions with patients should address both the potential benefits and potential harms of aspirin therapy. The new recommendation provides more specific guidance about benefits and harms to specific age groups and sex-specific benefits.

The Task Force recommends that men between the ages of 45 and 79 should use aspirin to reduce their risk for heart attacks when the benefits outweigh the harms for potential gastrointestinal bleeding. Women between the ages of 55 and 79 should use aspirin to reduce their risk for ischemic stroke when the benefits outweigh the harms for potential gastrointestinal bleeding. The risk of gastrointestinal bleeding with and without aspirin use increases with age and is twice as high in men as in women. Other risk factors for gastrointestinal bleeding include upper gastrointestinal tract pain, gastrointestinal ulcers, and using non-steroidal anti-inflammatory drugs.

The Task Force recommended against using aspirin to prevent either strokes or heart disease in men under 45 or women under age 55 because heart attacks are less likely to occur in men younger than 45 and ischemic strokes are less likely to occur in women younger than 55. In addition, limited evidence exists in these age groups.

The recommendations and materials for clinicians are available at http://www.ahrq.gov/clinic/uspstf/uspsasmi.htm

See "Aspirin for the prevention of cardiovascular disease: U.S. Preventive Services Task Force recommendation statement," in the March 17, 2009, Annals of Internal Medicine, 150(6), pp. 396-404.

Editor's Note: In March 2009, three new Members joined the U.S. Preventive Services Task Force. Select for additional information.

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