Article Impact Level: HIGH Data Quality: STRONG Summary of Internal Medicine. https://doi.org/10.1001/jamainternmed.2025.5049 Dr. Ahmed Sayed et al.
Points
- The USPSTF recommends considering aspirin for primary ASCVD prevention in adults aged 40-59 with ≥10% 10-year risk.
- This recommendation is currently based on the Pooled Cohort Equations, balancing benefit against bleeding risk.
- The newer PREVENT equations offer better calibration and result in lower 10-year ASCVD risk estimates.
- The implications of using PREVENT risk equations to determine aspirin eligibility had not been previously assessed.
- This study aims to evaluate how PREVENT equations might change aspirin use recommendations for primary prevention.
Summary
This research investigates the implications of using the novel Predicting Risk of Cardiovascular Disease EVENTs (PREVENT) equations to guide aspirin use for primary prevention of atherosclerotic cardiovascular disease (ASCVD), particularly in comparison to the established Pooled Cohort Equations (PCEs). The U.S. Preventive Services Task Force (USPSTF) currently recommends considering aspirin for primary prevention in adults aged 40 to 59 years with a 10-year ASCVD risk of 10% or greater, provided they are not at high bleeding risk; this recommendation is based on PCEs.
A critical consideration is that the PREVENT equations have demonstrated superior calibration compared to the PCEs, consistently yielding lower 10-year ASCVD risk estimates. This recalibration is significant because aspirin recommendations are carefully balanced between its potential cardiovascular benefits and the associated risk of major bleeding. Consequently, a downward adjustment in estimated ASCVD risk due to the use of PREVENT equations could substantially alter the number of individuals who meet the criteria for aspirin eligibility.
The study’s core objective is to assess these implications, as the impact of adopting PREVENT equations on aspirin eligibility has remained unexamined until now. Understanding how a more accurately calibrated risk assessment tool might modify current clinical guidance is vital for optimizing primary prevention strategies, minimizing unnecessary aspirin use (and thus bleeding risk), and ensuring that aspirin is recommended to those who stand to benefit most, within the USPSTF’s risk-benefit framework.
Link to the article: https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2839349
References
Sayed, A., Peterson, E. D., Khera, A., Virani, S. S., & Navar, A. M. (2025). Using the prevent equations to guide aspirin use for primary prevention of cardiovascular disease. JAMA Internal Medicine. https://doi.org/10.1001/jamainternmed.2025.5049
