Cardiovascular disease (CVD) and cancer are the leading causes of death among adults in the United States. Heart attacks and strokes are responsible for 30 percent of deaths and colorectal cancer, specifically, is the third most common cancer in the United States.
So it's important to tell patients that they can reduce their risk of CVD and colorectal cancer by quitting smoking, eating a healthy diet and being physically active. Controlling blood pressure and cholesterol also can help prevent heart attacks and strokes.
In addition, research has shown that taking low-dose aspirin every day for an extended period of time also can help prevent CVD and colorectal cancer in certain patients, and on Sept. 15, the U.S. Preventive Services Task Force (USPSTF) posted a draft recommendation statement(www.uspreventiveservicestaskforce.org) to that effect. The task force's B recommendation(www.uspreventiveservicestaskforce.org) applies to patients ages 50-59 who have an increased risk of heart attack and stroke but who are not at increased risk for bleeding, have at least a 10-year life expectancy and are willing to take low-dose aspirin daily.
This recommendation pertains specifically to patients who have not been diagnosed with CVD, said the USPSTF. However, if they haven't done so already, family physicians should advise patients with a history of heart attack or stroke to take aspirin to help prevent another cardiovascular event.
- On Sept. 15, the U.S. Preventive Services Task Force posted a draft recommendation statement supporting low-dose aspirin therapy for the primary prevention of cardiovascular disease (CVD) and colorectal cancer in patients ages 50-59 who have an increased risk of heart attack and stroke.
- The task force recommended physicians make individual decisions on preventive aspirin therapy for patients ages 60-69 at increased risk for CVD and cancer.
- In addition, the task force concluded that current evidence is insufficient to assess the balance of benefits and harms of aspirin use in adults younger than 50 or those 70 or older.
Patients ages 60-69 at increased risk for CVD and cancer also can benefit from taking aspirin. However, the USPSTF found that the overall benefit for this group is smaller, so the decision to take aspirin should be an individualized one based on the patient's risk for CVD and bleeding, overall health, and personal values and preferences (i.e., a C recommendation).
In addition, the task force concluded that current evidence is insufficient to assess the balance of benefits and harms of prophylactic aspirin use in adults younger than 50 or those 70 or older, issuing I statements for both age groups.
This is the first time the USPSTF has issued a recommendation regarding aspirin to prevent both CVD and colorectal cancer, although it released separate recommendations on preventing colorectal cancer in 2007 and CVD in 2009.
"Each person has only one decision to make -- whether or not to take aspirin for prevention," said USPSTF member Douglas Owens, M.D., M.S., in a news release.(www.uspreventiveservicestaskforce.org) "To help individuals and their clinicians make this decision, the task force integrated the evidence about the use of aspirin to prevent cardiovascular disease and colorectal cancer into one recommendation on the use of aspirin."
Update of Previous Recommendations
As previously noted, this recommendation updates the USPSTF's 2009 recommendation statement(www.uspreventiveservicestaskforce.org) on aspirin use to prevent CVD events and its 2007 D recommendation(www.uspreventiveservicestaskforce.org) against the use of aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) to prevent colorectal cancer in average-risk individuals.
The previous statement on preventing CVD recommended aspirin use for men ages 45-79 in whom the potential benefit of reducing myocardial infarction risk outweighed the potential harm from gastrointestinal hemorrhage and for women ages 55-79 in whom the potential benefit of reducing stroke risk outweighed the potential harm from gastrointestinal hemorrhage. However, the USPSTF concluded at the time that evidence was insufficient to assess the benefits and harms of aspirin use for those 80 or older, and it recommended against aspirin use for stroke prevention in women younger than 55 and for myocardial infarction prevention in men younger than 45.
The AAFP released parallel recommendations on aspirin use to prevent CVD and colorectal cancer.
To update its recommendations for the current draft statement, the USPSTF reviewed four additional studies on aspirin use for the prevention of CVD and several additional analyses of follow-up data on the prevention of colorectal cancer.
The task force also examined reviews of all-cause mortality and total cancer incidence and mortality, as well as a comprehensive review of harms. The USPSTF then used a microsimulation model to systematically estimate the balance of benefits and harms.
Family Physician's Take
Jennifer Frost, M.D., medical director for the AAFP Health of the Public and Science Division, told AAFP News that it makes sense to combine the recommendations for aspirin use in preventing CVD and colorectal cancer as both address primary prevention and target patients in the same age group.
The USPSTF uses the American College of Cardiology/American Heart Association Atherosclerotic Cardiovascular Disease 10-year pooled cohort risk calculator to determine risk, which includes age and gender. And this draft recommendation is the same for men and women with a 10-year risk of 10 percent or higher. Frost added that men will automatically have an increased risk score simply based on their gender.
As to why there is a stronger recommendation for patients ages 50-59 than those ages 60-69, she said aspirin has greater net benefit in the younger age range.
"This is because older adults, although at higher risk for cardiovascular disease, have a higher risk of bleeding," Frost said.
The USPSTF will accept comments on the draft recommendation statement(www.uspreventiveservicestaskforce.org) and its accompanying draft evidence reviews for aspirin use to prevent CVD(www.uspreventiveservicestaskforce.org) and cancer,(www.uspreventiveservicestaskforce.org) as well as an evidence review on the harms of aspirin use,(www.uspreventiveservicestaskforce.org) through Oct. 12.
The AAFP is reviewing the USPSTF's draft recommendation and will update its own recommendation after the task force publishes its final recommendation statement.
Related AAFP News Coverage
Study Links Long-term NSAID Use to Lower Colorectal Cancer Risk
USPSTF, AAFP Continue to recommend Against Routine Use of NSAIDs to Prevent Cancer