On April 12, the U.S. Preventive Services Task Force (USPSTF) issued its final recommendation statement(www.uspreventiveservicestaskforce.org) and evidence summaries on the use of aspirin for primary prevention of cardiovascular disease (CVD) and colorectal cancer.
To best inform physicians, the task force examined which patients would benefit most from taking aspirin based on the combined benefits and harms of taking the drug to prevent both CVD and colorectal cancer.
"Fortunately, the task force found that for 50- to 69-year-olds at increased risk for cardiovascular disease, taking aspirin can help prevent heart attacks and strokes as well as colorectal cancer," said Douglas Owens, M.D., M.S., a former USPSTF member who led the review, in a news release.(www.uspreventiveservicestaskforce.org)
Based on evidence the task force reviewed on taking low-dose aspirin for primary prevention of CVD(www.uspreventiveservicestaskforce.org) and colorectal cancer,(www.uspreventiveservicestaskforce.org) as well as bleeding risks,(www.uspreventiveservicestaskforce.org) the group recommended aspirin use for patients ages 50-59 who have a 10 percent or greater 10-year CVD risk, are not at increased risk for bleeding, have a life expectancy of at least 10 years and are willing to take the drug daily for at least 10 years. This is a B recommendation.(www.uspreventiveservicestaskforce.org)
- Based on evidence the U.S. Preventive Services Task Force reviewed on taking low-dose aspirin for primary prevention of cardiovascular disease (CVD), colorectal cancer and bleeding risks, the group recommended its use for patients ages 50-59 who have a 10 percent or greater 10-year CVD risk, are not at increased risk for bleeding, have a life expectancy of at least 10 years and are willing to take the drug daily for at least 10 years.
- However, for patients ages 60-69, the task force recommended approaching each case individually.
- For adults both younger than age 50 and older than age 70, the task force said current evidence is insufficient to assess the balance of benefits and harms of initiating aspirin use for primary prevention of CVD and colorectal cancer.
However, for patients ages 60-69, the USPSTF recommended approaching each case individually when determining whether to initiate low-dose aspirin use for primary prevention of CVD and colorectal cancer. This is a C recommendation.
For adults both younger than age 50 and older than age 70, the task force said current evidence is insufficient to assess the balance of benefits and harms of initiating aspirin use for primary prevention of CVD and colorectal cancer. These are I recommendations.
The AAFP released similar recommendations on aspirin use for prevention of CVD and colorectal cancer.
Taking aspirin is just one part of effective CVD and colorectal cancer prevention. Patients need to be reminded that they can reduce their risk of CVD and colorectal cancer by quitting smoking, eating a healthy diet and engaging in physical activity. They also should be told that controlling their blood pressure and cholesterol will help prevent heart attacks and strokes. Regular colorectal cancer screening also is integral in prevention efforts.
Update of Previous Recommendations
This is the first time the USPSTF has issued a recommendation for aspirin use in the prevention of both CVD and colorectal cancer, although it released separate recommendations on preventing colorectal cancer in 2007 and CVD in 2009.
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 USPSTF also previously recommended against the routine use of aspirin and nonsteroidal anti-inflammatory drugs to prevent colorectal cancer in individuals at average risk -- a D recommendation.
The AAFP released parallel recommendations on aspirin use to prevent CVD and colorectal cancer, respectively, at the time.
To update its recommendations for its final recommendation statement, the USPSTF reviewed five 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
Back in September, when the USPSTF released its draft recommendation statement on this topic, 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 because 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 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.
Related AAFP News Coverage
USPSTF: Certain At-risk Patients can Benefit From Statin Use
Evidence Lacking to Screen Children, Teens for Lipid Disorders