USPSTF No Longer Recommends Daily Aspirin for the Prevention of Heart Attack, Stroke for All Patients

In a new recommendation from the US Preventive Services Task Force (USPSTF), prescriptions for a daily regimen of low-dose aspirin for most people at high risk of a first heart attack or stroke should no longer be prescribed. This is the first updated recommendation since 2016.

“People ages 40 to 59 who are at higher risk for [cardiovascular disease (CVD)] and do not have a history of CVD should decide with their clinician whether to start taking aspirin,” explained the Task Force. “People age 60 or older should not start taking aspirin for heart disease and stroke prevention.”

According to the bulletin, the USPSTF explained that although daily aspirin has historically lowered the risk of a first heart attack or stroke, they also found that it can cause harm.

“The most serious potential harm is bleeding in the stomach, intestines, and brain. The chance of bleeding increases with age and can be life-threatening,” they explained.

The new recommendation from the Task Force suggests that once a patient turns 60 years of age, they should not take aspirin as a preventative measure. The Task Force says the risk of bleeding outweighs the benefits of preventing heart disease.

The USPSTF explained that new data “shows a closer balance of benefits and harms than previously understood for people in their 50s and that starting aspirin use as young as 40 years old may have some benefit.”

“Daily aspirin use may help prevent heart attacks and strokes in some people, but it can also cause potentially serious harms, such as internal bleeding,” said Task Force member John Wong, MD, in the bulletin.

“It’s important that people who are 40 to 59 years old and don’t have a history of heart disease have a conversation with their clinician to decide together if starting to take aspirin is right for them.”

Of important note, the new recommendation is only for patients who are at a higher risk of CVD, have no history of CVD, and who are not already taking daily aspirin.

“When deciding whether patients should start taking aspirin to prevent a first heart attack or stroke, clinicians should consider age, heart disease risk, and bleeding risk,” they explained.

“It is also important to consider a patient’s values and preferences. If someone is already taking aspirin and has any questions, they should talk to their clinician about their individual circumstances.”

Reference:
US Preventive Services Task Force (USPSTF). Task force issues draft recommendation statement on aspirin use to prevent cardiovascular disease. USPSTF website. October 8, 2021. https://www.uspreventiveservicestaskforce.org/uspstf/sites/default/files/file/supporting_documents/aspirin-cvd-prevention-final-rec-bulletin.pdf