USPSTF 2016: Aspirin for Primary Prevention of Cardiovascular Disease and Colorectal Cancer

Pearls from HippoEd’s Primary Care RAP (November 2016):

  • Low dose aspirin daily 81mg is used to provide primary prevention of CV disease (stroke and MI) and colon cancer.

  • USPSTF in April 2016 release new guidelines that recommended (Grade B) low dose aspirin for all adults aged 50-59 who met the following criteria:

    • 10% or greater 10-year CV disease risk

    • Not at increased risk of bleeding

    • Life expectancy of at least 10 years

    • Willing to take low dose aspirin daily for at least 10 years

  • The new guidelines focus on risk of GI bleeding, duration of therapy and no longer separate genders

  • For whom is low dose aspirin (ie: “baby aspirin”, 81mg daily) recommended in the primary prevention of CV disease and colorectal cancer? As of April 2016 USPSTF says the following adults would benefit:

    • Grade B: Adults age 50-59

      • 10% or greater 10-year CV disease risk

      • Not at increased risk of bleeding

      • Life expectancy of at least 10 years

      • Willing to take low dose aspirin daily for at least 10 years

    • Grade C: Adults aged 60-69 that meet the above criteria should be considered but ultimately the decision is an individual one

    • Not enough information either way: Adults aged greater than 70 or less than 50

  • What has changed in these new recommendations?

    • No more differences in gender

    • Emphasizing risk and duration of therapy (magic number is 10)

  • What are the benefits and risks? Aspirin prevents MI and colon cancer but does not prevent death from these conditions.

    • Women: If you have 1000 adults aged 50-59 that take an aspirin 365 day per year for 10 years, you prevent 15 MIs, 14 ischemic strokes and 14 cases of colorectal cancer. But you also cause 20 GI bleeds (usually upper GI) and 4 hemorrhagic strokes.

    • Men: Same group and intervention, you prevent 21 MIs, 9 ischemic strokes and 13 cases of colorectal cancer. You will also have 28 GI bleeds and 2 hemorrhagic strokes.

    • Net: saving 10-15 events per 100,000 patient years. The majority will see no benefit.

Recommendation Summary

Population Recommendation Grade
(What’s This?)
Adults aged 50 to 59 years with a ≥10% 10-year CVD risk The USPSTF recommends initiating low-dose aspirin use for the primary prevention of cardiovascular disease (CVD) and colorectal cancer (CRC) in adults aged 50 to 59 years who have a 10% 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 low-dose aspirin daily for at least 10 years. The USPSTF recommends the service. There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.
Adults aged 60 to 69 years with a ≥10% 10-year CVD risk The decision to initiate low-dose aspirin use for the primary prevention of CVD and CRC in adults aged 60 to 69 years who have a 10% or greater 10-year CVD risk should be an individual one. Persons who are not at increased risk for bleeding, have a life expectancy of at least 10 years, and are willing to take low-dose aspirin daily for at least 10 years are more likely to benefit. Persons who place a higher value on the potential benefits than the potential harms may choose to initiate low-dose aspirin. The USPSTF recommends against routinely providing the service. There may be considerations that support providing the service in an individual patient. There is at least moderate certainty that the net benefit is small.
Adults younger than 50 years The current evidence is insufficient to assess the balance of benefits and harms of initiating aspirin use for the primary prevention of CVD and CRC in adults younger than 50 years. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service. Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined.
Adults aged 70 years or older The current evidence is insufficient to assess the balance of benefits and harms of initiating aspirin use for the primary prevention of CVD and CRC in adults aged 70 years or older. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service. Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined.
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