Aspirin use as cardiovascular prophylaxis revisited

Washington -- Physicians should consider low-dose aspirin for men age 45 to 79 who are at risk for heart attack and women age 55 to 79 who are at risk for stroke, according to the U.S. Preventive Services Task Force, in an update to its 2002 recommendations.

This new version targets patients whose heart attack or stroke risks outweigh that of gastrointestinal bleeding. The preventive health panel reviewed research published since 2001 when drafting this document.

They determined good evidence now supports aspirin's value for these groups, especially for patients who are at increased risk for but have not yet experienced these problems. The panelists gave the recommendations an A, their highest grade.

Although the optimum aspirin dose is not known, the panelists determined that about 75 mg per day seemed as effective as higher doses and posed less of a bleeding risk.

Cardiovascular disease is the leading cause of death in the nation, underlying or contributing to 58% of deaths, noted the task force, which published its recommendation in the March 17 Annals of Internal Medicine (link). In 2003, one of every three U.S. adults had some form of cardiovascular disease.

In its 2002 recommendations, the task force strongly urged physicians to discuss the use of aspirin with adults who had an increased risk of coronary heart disease. Over the following years, additional research provided evidence that aspirin may have different benefits as well as harms for women and men, they noted.

Many physicians already were recommending aspirin for certain patients. The American Medical Association supports increasing physician awareness and education on the importance of appropriate aspirin counseling with patients.

The American College of Preventive Medicine is developing a national initiative, "Aspirin Talks: Start a Life-Saving Conversation." A 2007 study in the American Journal of Preventive Medicine indicated a conversation between patient and physician was the strongest predictor of appropriate aspirin use and that only about one in three patients at high risk are taking aspirin daily (link).

The task force is now advising such risk factors as age, blood pressure, diabetes and smoking be considered when recommending aspirin use for patients. The panelists said that for men, the additional risk factor of cholesterol level enters the equation. For women, the additional factors of a history of other cardiovascular disease, abnormal heart rhythms and the presence of an enlarged heart should be considered.