Summary of Recommendations for Aspirin Use to Prevent Cardiovascular Disease

Topic USPSTF Review of USPSTF Partnership for Prevention AHA Guidelines for Recommendations of Others Recommendation Rationale Women Aspirin for the Aspirin is recommended Good evidence exists that Discuss the Aspirin therapy (75 to 325 American Diabetes Association and Prevention of for men age 45 to 79 aspirin decreases the benefits/harms of daily mg/d) should be used in AHA jointly recommend aspirin CVD years when the potential incidence of myocardial aspirin use for the high-risk women unless therapy (75 to 162 mg/d) for primary benefit due to a reduction infarction in men and prevention of contraindicated (Class I, prevention of heart disease for persons in myocardial infarctions ischemic strokes in women, cardiovascular events Level A) . If a high-risk w/ diabetes age > 40 years or who outweighs the potential but also increases the with men >40, women woman is intolerant of have additional risk factors for CVD harm due to an increase in incidence of GI bleeding. >50, and others at aspirin therapy, clopidogre and no contraindications to aspirin gastrointestinal Fair evidence exists that increased risk. should be substituted therapy. American Stroke Association hemorrhage. (A) aspirin increases the (Class I, Level B) . In and AHA further recommend aspirin Aspirin is recommended incidence of hemorrhagic women >65 years of age, for cardiovascular prophylaxis among for women age 55 to 79 strokes. Aspirin use for the consider aspirin therapy persons whose risk is sufficiently high years when the potential prevention of CVD is only (81 mg daily or 100 mg for the benefits to outweigh the risks benefit of a reduction in recommended when every other day) if blood associated w/ treatment. For primary ischemic strokes sufficient evidence indicates pressure is controlled and prevention of stroke, they recommend outweighs the potential the benefits outweigh the benefit for ischemic stroke against aspirin in men and state that harm of an increase in harms. and MI prevention is likely aspirin can be useful for primary gastrointestinal to outweigh risk of prevention of stroke in women whose hemorrhage. (A) gastrointestinal bleeding risk is sufficiently high for the benefits and hemorrhagic stroke to outweigh the harms of treatment. (Class IIa, Level B) and in women <65 years of age when benefit for ischemic stroke prevention is likely to outweigh adverse effects of therapy (Class IIb, Level B) .

References:

Maciosek MV, Coffeild AB, Edwards NM, Flottemesch TJ, Goodman MJ, Solberg LI. Priorities among effective clinical preventive services: results of a systematic review and analysis. American Journal of Preventive Medicine. 2006;31(1). Available at http://www.prevent.org/data/files/initiatives/prioritiesamongeffectiveclinicalpreventivesvcsresultsofreviewandanalysis.pdf . Accessed on 8/23/10.

Mosca L, Banka CL, Benjamin EJ et al. Evidence-based guidelines for cardiovascular disease prevention in women: 2007 update. Circulation. 2007;115;1481-1501.

US Preventive Services Task Force. USPSTF Recommendations. Rockville (MD): U.S. Preventive Services Task Force. Available at http://www.uspreventiveservicestaskforce.org/uspstopics.htm . Accessed on 8/23/10.