Review the updated 2022 United States Preventive Task Force (USPSTF) guidelines on aspirin use to prevent cardiovascular disease (CVD) with Dr. John Wong.
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The 2022 USPSTF guidelines on aspirin use for primary CVD prevention recommend (USPSTF 2022):
**Applies to adults ages 40+ without a history of CVD or signs/symptoms of CVD
Daily low-dose aspirin use is associated with a small benefit in the reduction of cardiovascular events in adults 40 years or older who are at risk of CVD, and the benefits are greater for those with a higher 10-year CVD risk score (USPSTF 2022). Overall, the pooled analysis of 11 trials completed for this recommendation found a 12% reduction in nonfatal MI or CVA but no reduction in mortality from MI or CVA (USPSTF 2022). Early studies of aspirin use for primary CVD prevention identified a 45% reduction in the risk and mortality of MI or CVA (Physicians’ Health Study 1989). Dr. Wong describes results from three landmark trials published in 2018 on aspirin as primary CVD prevention as an example of the varying results reviewed:
Aspirin use in adults has been shown to increase the risk of gastrointestinal bleeding, intracranial bleeding and hemorrhagic CVA (USPSTF 2022). This risk is particularly notable in individuals greater than 60 years old. The incidence of major bleeding risks was found to be higher in the general population than previously thought, making the therapeutic window for aspirin’s benefit as primary prevention more narrow (Selak 2018).
The 2022 USPSTF update recommends considering aspirin initiation for primary CVD prevention at a younger age (40-59 years) for those with a ten-year CVD risk of >10% compared to the 2016 recommendation (50-59 years). This recommendation was changed from a Grade B recommendation in 2016 to a grade C recommendation in 2022 . The evidence review included an evaluation of aspirin’s effects on CRC incidence and mortality, but there was not enough evidence to make a recommendation (USPSTF 2022).
Listeners will review the updated 2022 USPSTF guidelines on aspirin use for cardiovascular disease prevention.
After listening to this episode listeners will…
Dr. Wong reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.
Gibson EG. Wong J. Williams PN.. “#347 USPSTF Update: Aspirin for Primary Prevention of CVD”. The Curbsiders Internal Medicine Podcast. http://thecurbsiders.com/episode-list Final publishing date, July 27 2021.
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