USPSTF Recommends Aspirin for Preventing CVD and Colorectal Cancer

By Kelly Young

Edited by David G. Fairchild, MD, MPH, and Jaye Elizabeth Hefner, MD

The U.S. Preventive Services Task Force recommends aspirin for primary prevention of cardiovascular disease and colorectal cancer in some high-risk adults in their 50s and 60s. The guidelines, an update of the group's 2007 and 2009 recommendations, are published in the Annals of Internal Medicine:

• Low-dose aspirin is recommended for adults aged 50–59 who have at least a 10% risk for a cardiovascular event in the next decade, low bleeding risk, and a life expectancy of at least 10 years; patients must also be willing to take aspirin daily for at least 10 years (grade B recommendation).

• For adults aged 60–69 fitting the above criteria, the decision to start aspirin should be an individual one (grade C).

• For patients younger than 50 and older than 69, there is not enough evidence to make recommendations (grade I).

Dr. Harlan Krumholz, editor-in-chief of NEJM Journal Watch Cardiology, comments: "The recommendations are sensible, but people should realize that they are based on very few high-quality studies — and no recent ones. Ultimately, aspirin's effects are felt to be modest, and the decision [to initiate treatment] is ideal for shared decision-making since there is some uncertainty about the relevance of the evidence to contemporary practice and a trade-off of risks and benefits."