USPSTF Recommendations: Role of Aspirin to Reduce CVD Risk
The 2022 USPSTF recommendations, based on the most current literature, provide updated guidance regarding the use of aspirin to reduce risk for cardiovascular disease (CVD). CVD is responsible for approximately 25% of deaths in the US and is currently the leading cause of mortality.
Evaluation of CVD risks
Effectiveness of aspirin to reduce the risk of CVD events (myocardial infarction and stroke) | Cardiovascular mortality | All-cause mortality in persons without a history of CVD
Harms: Primary focus on bleeding
GI bleeding | Intracranial hemorrhage | Hemorrhagic stroke
Adults ≥40 years
No signs or symptoms of CVD or known CVD (including history of myocardial infarction or stroke)
Not at increased risk for bleeding
Ages 40 to 59 years and ≥10-year CVD Risk
Decision to initiate low-dose aspirin use for the primary prevention of CVD should be an individual one
Evidence indicates that the net benefit of aspirin use in this group is small
Persons who are not at increased risk for bleeding and are willing to take low-dose aspirin daily are more likely to benefit
The USPSTF recommends selectively offering or providing this service to individual patients based on professional judgment and patient preferences
There is at least moderate certainty that the net benefit is small
Offer or provide this service for selected patients depending on individual circumstances
The USPSTF recommends against initiating low-dose aspirin use for the primary prevention of CVD
The USPSTF recommends against the service
There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits
Discourage the use of this service
CVD risk assessment tool
The American College of Cardiology/American Heart Association (ACC/AHA) Pooled Cohort Equations
May be used to estimate 10-year risk of CVD | Only validated US-based CVD risk prediction tool | Age is a main driver of risk for CVD
Risks using the ACC/AHA tool are only estimates
Bleeding risk is increased with the following
Increasing age | Male sex | Diabetes | GI history (e.g., peptic ulcer disease) | Liver disease | Smoking | Elevated BP | Certain medications (e.g., NSAIDs)
Recommendations of Others (see ‘Learn More – Primary Sources’)
The ACC/AHA recommends that low-dose aspirin use (75 to 100 mg/d) might be considered for the primary prevention of atherosclerotic CVD among select adults aged 40 to 70 years at higher CVD risk but not at increased risk of bleeding
Low-dose aspirin use is not recommended on a routine basis for primary prevention of CVD in adults >70 years or among adults of any age who are at increased risk of bleeding
Benefits of aspirin for CVD prevention appear similar for a low dose (≤100 mg/d) and for all doses that have been studied in CVD prevention trials (50 to 500 mg/d)
The USPSTF states that “A pragmatic approach would be to use 81 mg/d, which is the most commonly prescribed dose in the US”
OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.
Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
Jointly provided by
NOT ENOUGH CME HOURS
It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan