Putting Prevention into Practice
An Evidence-Based Approach
Aspirin Use for the Primary Prevention of Cardiovascular Disease and Colorectal Cancer
Am Fam Physician. 2016 Oct 15;94(8):661-662.
Author disclosure: No relevant financial affiliations.
S.L. is a 55-year-old man who presents to your office for a routine refill of his antihypertension medication. He also takes a statin and an antidepressant. Although he smokes, his blood pressure and cholesterol are well controlled. His history and physical examination are unremarkable.
Case Study Questions
According to the U.S. Preventive Services Task Force (USPSTF), which of the following factors would prompt consideration for S.L. to start taking low-dose aspirin to prevent cardiovascular disease (CVD) and colorectal cancer (CRC)?
A. Family history of CRC.
B. Life expectancy of at least 10 years.
C. Willingness to take low-dose aspirin daily for at least 10 years.
D. History of nonsteroidal anti-inflammatory drug (NSAID) use for arthritis.
S.L.'s 65-year-old brother visits you to ask about taking low-dose aspirin, although he admits that he sometimes forgets to take his medications. He does not smoke, and his blood pressure and cholesterol levels are normal. Which one of the following would you advise?
A. It is acceptable if he does not take aspirin every day, because any amount of aspirin reduces the risk of CVD and CRC.
B. It is acceptable if he does not take aspirin every day, but he should take a dosage of 325 mg at least once per month to maintain a therapeutic level.
C. He should use an enteric-coated formulation of aspirin to reduce the risk of gastrointestinal (GI) bleeding.
D. Initiate a discussion about his 10-year CVD risk, his willingness to take a daily pill, and his GI and overall health to determine whether aspirin will be of benefit to him.
S.L.'s 55-year-old wife is also
U.S. Preventive Services Task Force. Aspirin use for the primary prevention of cardiovascular disease and colorectal cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2016;164(12):836–845.
Guirguis-Blake JM, Evans CV, Senger CA, O'Connor EA, Whitlock EP. Aspirin for the primary prevention of cardiovascular events: a systematic evidence review for the U.S. Preventive Services Task Force. Ann Intern Med. 2016;164(12):804–813.
This PPIP quiz is based on the recommendations of the USPSTF. More information is available in the USPSTF Recommendation Statement and the supporting documents on the USPSTF website (http://www.uspreventiveservicestaskforce.org). The practice recommendations in this activity are available at http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/aspirin-to-prevent-cardiovascular-disease-and-cancer.
This series is coordinated by Sumi Sexton, MD, Associate Deputy Editor.
A collection of Putting Prevention into Practice published in AFP is available at http://www.aafp.org/afp/ppip.
Copyright © 2016 by the American Academy of Family Physicians.
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