Article Impact Level: HIGH Data Quality: STRONG Summary of Journal of the American Medical Association, 327(16), 1577–1584. https://doi.org/10.1001/jama.2022.4983 Dr. Karina Davidson et al
Points
- The new USPSTF recommendations do not suggest that everyone should use aspirin regularly for prevention of heart related problems. For individuals 60 years of age or older, the USPSTF advises against starting low-dose aspirin therapy for the sole prevention of cardiovascular disease (CVD)
- A recent study found that while taking aspirin for the main preventive measures of CVD events was linked to a reduced probability of myocardial infarction and stroke, neither CVD mortality nor all-cause mortality significantly decreased. These instructions specifically state that aspirin should be started, therefore individuals who are already taking aspirin shouldn’t stop taking it without first talking to their doctor
Summary
More than one in four deaths in the US are caused by cardiovascular disease (CVD), which is the primary cause of mortality. In the US, an estimated 610 000 people suffer their first stroke and 605 000 people have their first myocardial infarction each year. Blood clots have been proven to form in secondary prevention patients, thus it makes sense to use aspirin (ASA) to prevent clot formation in these patients. However, it is important to carefully consider the advantages and disadvantages of ASA use for people who are primary prevention.
A systematic review on the efficiency of aspirin to decrease the hazards of CVD events (myocardial infarction and stroke), cardiovascular mortality, and all-cause morbidity in people without a history of CVD was commissioned by the US Preventive Services Task Force (USPSTF) to update its 2016 recommendation. The research study also looked at the negative effects of aspirin use (especially bleeding) and how it affected the incidence and death of colorectal cancer (CRC) in populations used to prevent CVD. In addition, the USPSTF requested microsimulation modelling research to evaluate the overall balance of advantages and disadvantages associated with the use of aspirin for the primary prevention of CVD and CRC, stratified by age, sex, and CVD risk involved.
Adults 40 years of age or older who are not at increased risk for bleeding (e.g., no background of gastrointestinal ulcers, previous bleeding, numerous different medical conditions, or use of medications that increase bleeding risk) and who do not have noticeable symptoms of CVD or known CVD (including the history of myocardial infarction or stroke) were included. The USPSTF comes to the conclusion that there is no net advantage to starting aspirin usage for the primary prevention of CVD occurrences in persons 60 years of age or older. It should be up to each individual to decide whether to start taking low-dose aspirin for the primary prevention of CVD in individuals aged 40 to 59 who have a 10-year CVD risk of 10% or higher. Evidence suggests that there is little net benefit from aspirin use in this group. People who wish to consume low aspirin daily and are not at elevated risk for bleeding are likely to attain the benefits.
Link to the article: https://jamanetwork.com/journals/jama/fullarticle/2791399
References US Preventive Services Task Force. (2022). Aspirin use to prevent cardiovascular disease: Us preventive services task force recommendation statement. JAMA, 327(16), 1577–1584. https://doi.org/10.1001/jama.2022.4983
