The US Preventive Services Taskforce is recommending against initiating low-dose aspirin for the primary prevention of CVD in adults aged 60 years or older.
And the Task Force is lukewarm on the benefit in younger people 40-59 years even with a 10% or greater 10-year CV risk based on the ACC/AHA risk calculator.
“The USPSTF concludes with moderate certainty that aspirin use for the primary prevention of CVD events in adults ages 40 to 59 years who have a 10% or greater 10-year CVD risk has a small net benefit.”
USPTF concerns hinge on evidence that aspirin increases the risk for gastrointestinal bleeding, intracranial bleeding, and hemorrhagic stroke.
“The USPSTF determined that the magnitude of the harms are small overall but increase in older age groups, particularly in adults older than age 60 years.”
“Decisions about initiating aspirin use should be based on shared decision making between clinicians and patients about the potential benefits and harms,” it said.
They said people who place a higher value on the potential benefits than the potential harms may choose to initiate low-dose aspirin use.
“Persons who place a higher value on the potential harms or on the burden of taking a daily preventive medication than the potential benefits may choose not to initiate low-dose aspirin use.”
The statement is an update of the 2016 recommendations which used different age ranges and recommended initiating low-dose aspirin use for the primary prevention of CVD in adults ages 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.
In 2016 they also said that the decision to initiate low-dose aspirin use in adults ages 60 to 69 years who have a 10% or greater 10-year CVD risk should be an individual one.
At that time, the USPSTF found that the evidence was insufficient to assess the balance of benefits and harms of initiating low-dose aspirin use in adults younger than 50 years or older than 70 years.
The draft recommendations are open for public comment until 8 November 2021.