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Don Lavoie is alcohol programme manager at Public Health England and Gul Root is lead pharmacist, Health and Wellbeing Directorate, Public Health England
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aspirin pill bigApril 13 2016

Adults in their 50s should take low-dose aspirin for the primary prevention of cardiovascular disease and colorectal cancer, an independent US expert panel has recommended.

Patients in this age group for whom the recommendation applies are those who have a 10% or greater 10-year CVD risk or are at average risk of colorectal cancer, are not at increased risk of bleeding, have a life expectancy of at least 10 years, and are willing to take low-dose aspirin for at least 10 years.

The recommendation has been made by the US Preventive Services Task Force, “an independent, volunteer panel of national experts in prevention and evidence-based medicine.” It has assessed the available evidence for aspirin use for people in their 50s as grade B. This suggests either that there is high certainty that the net benefit is moderate or that there is moderate certainty that the net benefit is moderate to substantial.

The evidence for low-dose aspirin’s use in people in their 60s is slightly lower, prompting the USPSTF to say: “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,” the USPSTF said. It has not made any recommendations on low-dose aspirin for people under 50 or over 70.

Setting out its analysis of the data, the Task Force said that it had found adequate evidence that aspirin is of “moderate benefit” to reduce the risk of cardiovascular events such as nonfatal myocardial infarction and stroke in adults in their 50s and of increased CVD risk. It also found that aspirin use reduces the risk of colorectal cancer after five to ten years of use.

While aspirin can increase the risk of gastrointestinal bleeding and haemorrhagic stroke, it said “the harms vary but are small in adults aged 59 years or younger and small to moderate in adults aged 60 to 69 years. The USPSTF found inadequate evidence to determine the harms of aspirin use in adults aged 70 years or older.”

The USPSTF had consulted on a draft recommendation last autumn. It has published the final recommendation in the Annals of Internal Medicine on April 12 2016.

Links:

USPSTF recommendation summary

USPSTF Final Recommendation Statement

K Bibbins-Domingo et al. ‘Aspirin Use for the Primary Prevention of Cardiovascular Disease and Colorectal Cancer: U.S. Preventive Services Task Force Recommendation Statement’. Ann Intern Med. Published online April 12 2016

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