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.
Mora S, Shufelt CL, Manson JE. Whom to Treat for Primary Prevention of Atherosclerotic Cardiovascular Disease: The Aspirin Dilemma. JAMA Intern Med. 2022;182(6):587–589. doi:10.1001/jamainternmed.2022.1365
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