There are many physicians who suggest that their patients take low-dose aspirin for ten years or more to prevent cardiovascular disease and colorectal cancer. Should everyone over the age of 50 be doings this? Well sure enough, there was a viewpoint article about this issue in this week’s issue of JAMA.
The authors (physicians at Brigham and Women’s Hospital, the Harvard Medical School) pointed out that despite numerous studies, there is limited formal guidance on appropriate use of aspirin for primary prevention of cardiovascular disease in clinical practice.
The 2016 US Preventive Services Task Force (USPSTF) now grades recommendations about low-dose aspirin use for prevention of cardiovascular disease and colorectal cancer. (That’s one way of avoiding a blanket recommendation!) So here they are:
• For adults age 50 to 59 use of low-dose aspirin (75-81 mg), they give a grade B recommendation… provided the individuals meet all of the following criteria: (1) 10 year risk of cardiovascular disease of at least 10%; (2) at least 10 years of life expectancy and willingness to take aspirin; and (3) no increased risk of bleeding (eg, no recent bleeding, no recent history of gastrointestinal ulcers and no use of medications that increase bleeding risk such as anticoagulant or antiplatelet agents).
• For adults age 60 to 69 years meeting the above criteria, the USPSTF gives a grade C recommendation (not routinely recommended; individualize the decision).
• For all adults younger than 50 years and age 70 years or older they consider the evidence to be insufficient.
There are studies that show a decreased risk of heart disease and colorectal cancer in those who take low-dose aspirin for 10 years. But in an attempt to clear the aspirin air, the USPSTF felt it appropriate to qualify decisions with their grades. Not all doctors concur.
So if you want to consider taking aspirin, you should discuss this with your physician and your decision should be made on a highly individual basis. (Basically, this is the kind of good advice that is given on most medical therapy decisions…)
I have not routinely taken baby aspirin over the past decades, but do take one before I take a long flight. I had a minor bike accident a week ago and as I surveyed my bruises, I was somewhat happy to know that I was not on aspirin. I was also happy that I didn’t break any bones…