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US panel recommends low dose aspirin to prevent cardiovascular disease and colorectal cancer

BMJ 2016; 352 doi: https://doi.org/10.1136/bmj.i2061 (Published 12 April 2016) Cite this as: BMJ 2016;352:i2061
  1. Michael McCarthy
  1. Seattle

The US Preventive Services Task Force has recommended low dose aspirin for the primary prevention of cardiovascular disease and colorectal cancer in adults aged 50 to 59 years who are at high risk of cardiovascular disease.

The recommendations apply to adults who have a 10% or greater 10 year risk of a cardiovascular event, are not at risk of gastrointestinal 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 recommendations and accompanying evidence reviews appeared in Annals of Internal Medicine on 12 April.1 2 3 4

Cardiovascular disease is responsible for more than half of all deaths in the United States, and colorectal cancer is one of the leading causes of death from cancer. Although low dose aspirin can reduce the risk of heart attacks, stroke, and colorectal cancer, its use is also associated with an increased risk of gastrointestinal bleeding and hemorrhagic stroke. In its various evaluations the task force seeks to balance the benefits with the harms of the interventions it evaluates.

The decision whether to take low dose aspirin for the primary prevention of cardiovascular disease should be an individual one for adults aged 60 to 69 who have a 10% or greater 10 year risk, the task force also said. “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,” the task force said.

Patients need to take low dose aspirin for 5-10 years to realize the benefit in reducing the risk of colorectal cancer, the task force noted. It said, “Persons with shorter life expectancy are less likely to realize this benefit; thus, aspirin use is more likely to have an effect when it is started between the ages of 50 and 59 years. Because of the time required before a reduced incidence in CRC [colorectal cancer] is seen, older persons (that is, 60 years or older) are less likely to realize this benefit than adults aged 50 to 59 years.”

The task force concluded that the evidence to assess the benefits and harms of starting aspirin for the primary prevention of cardiovascular disease and colorectal cancer among adults younger than 50 and older than 70 was insufficient.

Assessment of the magnitude of a person’s risk of cardiovascular events should include such factors as age, sex, cholesterol concentrations, blood pressure, and history of diabetes and of smoking, said the task force, which recommended the use of the American College of Cardiology and American Heart Association’s online risk calculator (http://tools.acc.org/ASCVD-Risk-Estimator).

The optimal dose for preventing cardiovascular disease was not known, the task force said, with primary prevention trials seeing benefits with doses of 75 mg and 100 mg a day and 100 mg and 325 mg every other day. “A dose of 75 mg per day seems as effective as higher doses,” it said.

The task force is composed of experts in primary care and evidence based medicine, who work as volunteers. It makes recommendations for the preventive care of patients who have no signs or symptoms of the diseases or conditions being considered. The work of the task force is funded by the US Agency for Healthcare Research and Quality.

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