Benefit of Aspirin to Prevent CVD and CRC Upheld by USPSTF

The US Preventive Services Task Force (USPSTF) has published an update to the recommended use of aspirin to prevent cardiovascular disease (CVD) and colorectal cancer (CRC). The new recommendation advises the use of low-dose aspirin in adults 50 to 69 years of age, who have an increased risk of CVD, are not at an increased risk of bleeding, and have a life expectancy of at least 10 years, for the prevention of CVD and CRC.

The recommendation, published in the Annals of Internal Medicine, makes an age-based distinction: adults in the 50 to 59 age group with a 10% or greater 10-year CVD risk get a B recommendation, while the older adults in the 60 to 69 age group with an equivalent risk have been advised to make the decision at a personalized level (a C recommendation). The Task Force believes the existing evidence of any advantage of a daily dose of aspirin is insufficient to make any recommendations for adults younger than 50 years of age or in those older than 70 years of age.

Considering the high rate of CVD— and CRC–associated deaths in the United States, these recommendations can have a significant beneficial effect. USPSTF recognized the following as primary risk factors for CVD:

• Older age
• Male gender
• Race/ethnicity
• Abnormal lipid levels
• High blood pressure
• Diabetes
• Smoking

A calculator derived from the American College of Cardiology/American Heart Association pooled cohort equations was used to predict the 10-year risk for first hard atherosclerotic CVD event. Risk factors for gastrointestinal (GI) bleeding with aspirin use include higher dose and longer duration of use, history of GI ulcers or upper GI pain, bleeding disorders, renal failure, severe liver disease, and thrombocytopenia. So those who are at an increased risk for CVS and known to have a risk for CRC based on family history of CRC or familial adenomatous polyposis are advised to speak with their physician.

With respect to CRC, it is important to remember that the benefit of low-dose aspirin are not apparent till 10 years following initiation of the preventive treatment—this translates into restricting use to those who have a longer life expectancy. “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 is seen, older persons (that is, 60 years or older) are less likely to realize this benefit than adults aged 50 to 59 years,” according to the Task Force.

Reference

Bibbins-Domingo K; U.S. Preventive Services Task Force. Aspirin Use for the primary prevention of cardiovascular disease and colorectal cancer: U.S. Preventive Services Task Force recommendation statement [Published online Apr 12, 2016]. Ann Intern Med. doi:10.7326/M16-0577.