Low-dose aspirin does not help prevent cardiovascular disease like once thought, and physicians should prescribe it in a relatively narrow set of circumstances.
That’s according to the latest recommendation from the U.S. Preventive Services Task Force (USPSTF). Based on that conclusion, the task force tells health care professionals “with moderate certainty that aspirin use for the primary prevention of CVD [cardiovascular disease] events in adults aged 40 to 59 years who have a 10% or greater 10-year CVD risk has a small net benefit,” according to an article published in the Journal of the American Medical Association (JAMA).
USPSTF also concluded with moderate certainty that “initiating aspirin use for the primary prevention of CVD events in adults 60 years or older has no net benefit.”
The recommendation builds on a consensus that has been developing for years based on research about the efficacy and safety of low-dose, or “children’s,” aspirin, says Eduardo Sanchez, MD, chief medical officer for prevention at the American Heart Association (AHA) in Dallas. For instance, the AHA in 2019 issued recommendations that played up preventing cardiovascular disease with a healthy lifestyle and stated that aspirin should be used infrequently because of the lack of benefit.
“Unless you are a person who has had a stroke, a heart attack, vascular stenting, or atrial fibrillation, you probably should not be taking aspirin for primary prevention of cardiovascular disease,” Dr. Sanchez said. “And ‘probably’ is the right word, because if you have thought maybe you should, that’s a conversation you should have with your doctor because there may be some good reasons for that in very, very limited circumstances.”
In 2016, USPSTF recommended initiating low-dose aspirin use for the primary prevention of cardiovascular disease in adults aged 50 to 59 years who have a 10% or greater 10-year cardiovascular disease risk, are not at increased risk for bleeding, have a life expectancy of at least 10 years, and are willing to take low-dose aspirin daily for at least 10 years, the JAMA article explains. Also, the 2016 guidance stated the decision to initiate low-dose aspirin use in adults aged 60 to 69 years who have a 10% or greater 10-year CVD risk should be an individual one.
That has changed.
“For the current recommendation, the USPSTF has changed the age ranges and grades of its recommendation on aspirin use,” the JAMA article says. “The USPSTF recommends that the decision to initiate low-dose aspirin use for the primary prevention of [cardiovascular disease] in adults aged 40 to 59 years who have a 10% or greater 10-year [cardiovascular disease] risk should be an individual one and recommends against initiating low-dose aspirin use for the primary prevention of [cardiovascular disease] in adults 60 years or older.”
Updated scientific studies and reviews showed low-dose aspirin use was associated with a 58% increase in major gastrointestinal bleeding as well as an increase in intracranial bleeding, according to JAMA.
“This is a science-based recommendation from an updated review of the side-effects, or the downside, of aspirin,” Dr. Sanchez said. “The risk of gastrointestinal bleeding and intracranial bleeding is high enough that it neutralized or superseded the benefit of taking aspirin. … It’s basically a risk-benefit analysis, and the risks outweigh the benefits.”
The USPSTF study also examined the impact of low-dose aspirin on colorectal cancer; those “results were less robust and highly variable.”