Whom to Treat for Primary Prevention of Atherosclerotic Cardiovascular Disease: The Aspirin Dilemma

The US Preventive Services Task Force (USPSTF) has released its updated 2022 recommendations,¹ supported by an updated evidence report,² to guide the use of low-dose aspirin for the primary prevention of atherosclerotic cardiovascular disease (ASCVD), changing the age ranges and recommendation grades and focusing on preventing ASCVD events. It now gives a C recommendation (recommend individualizing the decision to initiate low-dose aspirin) for adults aged 40 to 59 years with a 10-year ASCVD risk 10% or greater and not at increased bleeding risk, and a D recommendation (recommend against initiating) for those 60 years and older (Table). For colorectal cancer, the 2022 recommendations concluded that the data were insufficient. This contrasts with the 2016 USPSTF recommendations,³ which addressed both ASCVD and colorectal cancer prevention and gave a B recommendation (recommend initiating) for adults aged 50 to 59 years with a 10-year ASCVD risk 10% or greater with a life expectancy of at least 10 years and not at increased bleeding risk, a C recommendation (recommend individualizing the decision to initiate low-dose aspirin) for select adults aged 60 to 69 years with a 10-year ASCVD risk 10% or greater, and I recommendation (insufficient evidence) for adults 70 years and older or younger than 50 years.