Aspirin Use to Prevent Cardiovascular Disease: US Preventive Services Task Force Recommendation Statement.
Level 1 - systematic review of randomized trials
Practice guideline based on commissioned systematic review of randomized trials and microsimulation modeling
PubMed 35471505 · doi:10.1001/jama.2022.4983
What was done
The US Preventive Services Task Force (USPSTF) updated its 2016 recommendation by commissioning a systematic review on the efficacy of aspirin to reduce cardiovascular disease (CVD) events (myocardial infarction and stroke), cardiovascular mortality, all-cause mortality, and colorectal cancer incidence and mortality in persons without CVD history. Harms, particularly bleeding, were also evaluated. The USPSTF additionally commissioned a microsimulation modeling study to assess net benefits and harms stratified by age, sex, and CVD risk level in adults aged 40 years or older without known CVD or increased bleeding risk.
What was found
The abstract reports background epidemiological figures (CVD causes >1 in 4 US deaths, with an estimated 605,000 first myocardial infarctions and 610,000 first strokes annually in the US), but gives no numerical outcome estimates, effect sizes, or event rates from the underlying evidence base. For adults aged 40 to 59 years with a 10-year CVD risk of 10% or greater, the USPSTF concluded with moderate certainty that daily low-dose aspirin has a small net benefit, recommending an individualized decision (C recommendation). For adults aged 60 years or older, the USPSTF concluded with moderate certainty that initiating low-dose aspirin provides no net benefit, recommending against initiation (D recommendation).
Why it matters
This guideline clarifies the primary prevention balance of benefits and bleeding harms, advising against initiating aspirin in adults 60 years or older and restricting initiation to an individualized decision in adults aged 40 to 59 with elevated risk.
Limits
The abstract reports no numerical risk reductions or bleeding rates. The conclusions apply strictly to primary CVD prevention in persons not at increased bleeding risk and do not evaluate continuing aspirin in patients already taking it.
Cited by
- supports The American Medical Association evaluated the balance of stomach bleeding risks against cardiovascular event reduction and concluded against generalized baby aspirin use for the broad population.