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Aspirin Use to Prevent Cardiovascular Disease and Colorectal Cancer, Preventive Medication, 2016

* Indicates an old grade definition


Recommendations: Preventive Medication for Aspirin Use to Prevent Cardiovascular Disease and Colorectal Cancer

  • Aspirin Use to Prevent CVD and CRC: Preventive Medication --Adults aged 50 to 59 years with a ≥10% 10-year CVD risk
    Grade: B
    Specific Recommendations:

    The USPSTF recommends initiating low-dose aspirin use for the primary prevention of cardiovascular disease (CVD) and colorectal cancer (CRC) in adults aged 50 to 59 years who have a 10% or greater 10-year CVD risk, 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.

    Frequency of Service:

    The optimal dose of aspirin to prevent CVD events is not known. Primary prevention trials have demonstrated benefits with various regimens, including doses of 75 and 100 mg per day and 100 and 325 mg every other day. A dose of 75 mg per day seems as effective as higher doses. The risk for GI bleeding may increase with the dosage. A pragmatic approach consistent with the evidence is to prescribe 81 mg per day, which is the most commonly prescribed dose in the United States.

    Although the optimal timing and frequency of discussions about aspirin therapy are unknown, a reasonable approach may be to assess CVD and bleeding risk factors starting at age 50 years and periodically thereafter, as well as when CVD and bleeding risk factors are first detected or change.

    Risk Factor Information:

    Risk assessment for CVD should include ascertainment of the following risk factors: age, sex, race/ethnicity, total cholesterol level, high-density lipoprotein cholesterol level, systolic blood pressure, hypertension treatment, diabetes, and smoking. An online version of the ACC/AHA risk calculator can be found at http://tools.acc.org/ASCVD-Risk-Estimator/.

    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. Other factors that increase risk for GI or intracranial bleeding with low-dose aspirin use include concurrent anticoagulation or nonsteroidal anti-inflammatory drug (NSAID) use, uncontrolled hypertension, male sex, and older age.4, 5

    This recommendation applies to adults who are at increased CVD risk and at average risk for CRC. Persons who are at increased CVD risk and are known to be at increased risk for CRC (for example, persons with a family or personal history of CRC or familial adenomatous polyposis)6 should consult their health care provider.

  • Aspirin Use to Prevent CVD and CRC: Preventive Medication --Adults aged 60 to 69 years with a ≥10% 10-year CVD risk
    Grade: C
    Specific Recommendations:

    The decision to initiate low-dose aspirin use for the primary prevention of CVD and CRC in adults aged 60 to 69 years who have a 10% or greater 10-year CVD risk should be an individual one. 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. Persons who place a higher value on the potential benefits than the potential harms may choose to initiate low-dose aspirin.

    Frequency of Service:

    The optimal dose of aspirin to prevent CVD events is not known. Primary prevention trials have demonstrated benefits with various regimens, including doses of 75 and 100 mg per day and 100 and 325 mg every other day. A dose of 75 mg per day seems as effective as higher doses. The risk for GI bleeding may increase with the dosage. A pragmatic approach consistent with the evidence is to prescribe 81 mg per day, which is the most commonly prescribed dose in the United States.

    Although the optimal timing and frequency of discussions about aspirin therapy are unknown, a reasonable approach may be to assess CVD and bleeding risk factors starting at age 50 years and periodically thereafter, as well as when CVD and bleeding risk factors are first detected or change.

    Risk Factor Information:

    Risk assessment for CVD should include ascertainment of the following risk factors: age, sex, race/ethnicity, total cholesterol level, high-density lipoprotein cholesterol level, systolic blood pressure, hypertension treatment, diabetes, and smoking. An online version of the ACC/AHA risk calculator can be found athttp://tools.acc.org/ASCVD-Risk-Estimator/.

    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. Other factors that increase risk for GI or intracranial bleeding with low-dose aspirin use include concurrent anticoagulation or nonsteroidal anti-inflammatory drug (NSAID) use, uncontrolled hypertension, male sex, and older age.4, 5

    This recommendation applies to adults who are at increased CVD risk and at average risk for CRC. Persons who are at increased CVD risk and are known to be at increased risk for CRC (for example, persons with a family or personal history of CRC or familial adenomatous polyposis)6 should consult their health care provider.

  • Aspirin Use to Prevent CVD and CRC:Preventive Medication--Adults younger than 50 years
    Grade: I
    Specific Recommendations:

    The current evidence is insufficient to assess the balance of benefits and harms of initiating aspirin use for the primary prevention of CVD and CRC in adults younger than 50 years.

    Frequency of Service:

    No Frequency of Service information currently available.

    Risk Factor Information:

    No Risk Factor Information currently available.

  • Aspirin Use to Prevent CVD and CRC:Preventive Medication--Adults aged 70 years or older
    Grade: I
    Specific Recommendations:

    The current evidence is insufficient to assess the balance of benefits and harms of initiating aspirin use for the primary prevention of CVD and CRC in adults aged 70 years or older.

    Frequency of Service:

    No Frequency of Service information currently available.

    Risk Factor Information:

    No Risk Factor Information currently available.

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