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Pendulum swings further away from aspirin for CVD primary prevention

Reuters Health - 26/04/2022 - The U.S. Preventive Services Task Force (USPSTF) has changed its recommendation on low-dose aspirin for primary prevention of cardiovascular disease (CVD).

Based on the latest available evidence, the task force now recommends against starting low-dose aspirin use for the primary prevention of CVD in adults 60 years or older (grade D; "discourage" use).

The task force has also downgraded its recommendation on aspirin for primary prevention in adults aged 40 to 59 years with an estimated 10% or greater 10-year risk of CVD. The 2016 grade B recommendation (offer or provide this service) is now a grade C recommendation (offer or provide this service for selected patients depending on individual circumstances).

In this group, "evidence indicates that the net benefit of aspirin use in this group is small," the task force says, and the decision to start low-dose aspirin for primary CVD prevention in this group "should be an individual one."

Individuals who are not at increased risk for bleeding and are willing to take low-dose aspirin daily are more likely to benefit, the task force says.

They advise individuals who are currently taking aspirin and have questions about why they are taking it, or whether they should continue or discontinue aspirin use, to talk with their healthcare provider.

"Persons who are taking aspirin should not discontinue using it without consulting their clinician. For persons who are deciding with their clinician whether to continue or discontinue taking aspirin for primary prevention, clinicians may want to consider that person's age, level of CVD risk and bleeding risk, preferences, and reasons for taking aspirin," the task force says.

In its updated recommendations, the task force also says it remains unclear whether aspirin use reduces the risk of developing or dying from colorectal cancer.

The USPSTF updated recommendations and evidence report are published in JAMA.

"These recommendations align well with the American College of Cardiology (ACC) / American Heart Association (AHA) 2019 guidelines and for similar underlying evidence-based reasons," writes AHA President Dr. Donald Lloyd-Jones in an editorial in JAMA Cardiology.

"The draft and final versions of the new USPSTF recommendations for primary preventions were and are correct and appropriately reflect the progress of the evidence base, although they differ somewhat in substance and scope from the ACC/AHA guidelines," he points out.

"The lesson for all guideline-producing organizations is the importance of ensuring clear and broad-based communication strategies in the introduction of updated recommendations, and whom they affect and do not affect, based on new and improved evidence. Patients depend on us to do that," Dr. Lloyd-Jones concludes.

SOURCE: https://bit.ly/3Ld9Fia JAMA, online April 26, 2022.

By Reuters Staff


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