The US Preventive Services Task Force recently updated its recommendations regarding daily aspirin use as primary prevention for cardiovascular disease and colon cancer.
The US Preventive Services Task Force (USPSTF) recently updated its recommendations regarding daily aspirin use as primary prevention for cardiovascular disease (CVD) and colon cancer.
The guidelines published online in the Annals of Internal Medicine updated the USPSTF’s 2009 recommendations on aspirin use to prevent CVD events and 2007 recommendations on aspirin and nonsteroidal anti-inflammatory drug (NSAID) use to prevent colon cancer.
Given that CVD-related deaths are on the rise worldwide, pharmacists should heed the following key aspects of the USPSTF’s updated aspirin use guidelines.
1. The recommendation for daily aspirin use as primary CVD prevention only applies to patients who meet specific criteria.
According to the updated guidelines, health care professionals should initiate low-dose aspirin for primary prevention in men and women who meet all of the following criteria:
· Aged 50 to 69 years old
· 10% or greater 10-year CVD risk
· Average risk for colon cancer
· No increased risk for bleeding
· Life expectancy of at least 10 years
· Willing to take low-dose aspirin daily for at least 10 years
The USPSTF explained that “the evidence on aspirin use in adults younger than 50 years or older than 69 years is insufficient and the balance of benefits and harms cannot be determined.”
Of note, the primary risk factors for CVD are:
· Age >65 years
· Male gender
· Genetic predisposition
· High cholesterol
· High blood pressure
· Physical inactivity
· Being overweight
2. It’s too late to use aspirin as primary prevention in patients who already experienced a heart attack or stroke, or had a stent placed in an artery.
Patients who previously had a stent inserted or experienced a heart attack or stroke are already at high risk for recurrence, so daily aspirin use could only serve as secondary prevention in this population.
Beta-blockers, angiotensin-converting enzyme inhibitors, statins, and calcium channel blockers are especially beneficial in post-heart attack patients.
Each year, about 1 million patients in the United States are hospitalized for acute myocardial infarction. Of these patients, 470,000 are expected to have a recurrent major adverse cardiovascular event.
Pharmacists can help reduce the risk of recurrent events by educating patients on treatment adherence and modifiable risk factors, such as weight loss and smoking cessation.
3. Potential harms related to aspirin use may have been downplayed before.
While reviewing published literature on aspirin use, the USPSTF discovered that the risks of severe bleeding were higher than what clinical trials previously documented.
Namely, daily use of aspirin in adults seems to increase the risk for gastrointestinal bleeding and hemorrhagic stroke.
Similarly, the FDA issued a report in 2014 that didn’t support daily aspirin use for the primary prevention of heart attack or stroke and suggested that patients only start aspirin therapy after speaking with a health care professional.
After analyzing evidence collected from major studies, the FDA concluded that the risks associated with daily aspirin use, such as bleeding into the brain or stomach, could outweigh benefits for patients without a history of heart attack, stroke, or cardiovascular problems.
“The bottom line is that in people who have had a heart attack, stroke, or cardiovascular problems, daily aspirin therapy is worth considering,” the updated USPSTF guidelines suggested. “But if you’re thinking of using aspirin therapy, you should first talk to your health care professional to get an informed opinion.”