Aspirin Use to Prevent Cardiovascular Disease: US Preventive Services Task Force Recommendation Statement | Cardiology | JN Learning | AMA Ed Hub [Skip to Content]
[Skip to Content Landing]

Aspirin Use to Prevent Cardiovascular DiseaseUS Preventive Services Task Force Recommendation Statement

To identify the key insights or developments described in this article
1 Credit CME
Abstract

Importance  Cardiovascular disease (CVD) is the leading cause of mortality in the US, accounting for more than 1 in 4 deaths. Each year, an estimated 605 000 people in the US have a first myocardial infarction and an estimated 610 000 experience a first stroke.

Objective  To update its 2016 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a systematic review on the effectiveness of aspirin to reduce the risk of CVD events (myocardial infarction and stroke), cardiovascular mortality, and all-cause mortality in persons without a history of CVD. The systematic review also investigated the effect of aspirin use on colorectal cancer (CRC) incidence and mortality in primary CVD prevention populations, as well as the harms (particularly bleeding) associated with aspirin use. The USPSTF also commissioned a microsimulation modeling study to assess the net balance of benefits and harms from aspirin use for primary prevention of CVD and CRC, stratified by age, sex, and CVD risk level.

Population  Adults 40 years or older without signs or symptoms of CVD or known CVD (including history of myocardial infarction or stroke) who are not at increased risk for bleeding (eg, no history of gastrointestinal ulcers, recent bleeding, other medical conditions, or use of medications that increase bleeding risk).

Evidence Assessment  The USPSTF concludes with moderate certainty that aspirin use for the primary prevention of CVD events in adults aged 40 to 59 years who have a 10% or greater 10-year CVD risk has a small net benefit. The USPSTF concludes with moderate certainty that initiating aspirin use for the primary prevention of CVD events in adults 60 years or older has no net benefit.

Recommendation  The decision to initiate low-dose aspirin use for the primary prevention of CVD in adults aged 40 to 59 years who have a 10% or greater 10-year CVD risk should be an individual one. Evidence indicates that the net benefit of aspirin use in this group is small. Persons who are not at increased risk for bleeding and are willing to take low-dose aspirin daily are more likely to benefit. (C recommendation) The USPSTF recommends against initiating low-dose aspirin use for the primary prevention of CVD in adults 60 years or older. (D recommendation)

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 CME Credit™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Corresponding Author: Karina W. Davidson, PhD, MASc, Feinstein Institutes for Medical Research, 130 E 59th St, Ste 14C, New York, NY 10032 (chair@uspstf.net).

Accepted for Publication: March 21, 2022.

The US Preventive Services Task Force (USPSTF) members: Karina W. Davidson, PhD, MASc; Michael J. Barry, MD; Carol M. Mangione, MD, MSPH; Michael Cabana, MD, MA, MPH; David Chelmow, MD; Tumaini Rucker Coker, MD, MBA; Esa M. Davis, MD, MPH; Katrina E. Donahue, MD, MPH; Carlos Roberto Jaén, MD, PhD, MS; Alex H. Krist, MD, MPH; Martha Kubik, PhD, RN; Li Li, MD, PhD, MPH; Gbenga Ogedegbe, MD, MPH; Lori Pbert, PhD; John M. Ruiz, PhD; James Stevermer, MD, MSPH; Chien-Wen Tseng, MD, MPH, MSEE; John B. Wong, MD.

Affiliations of The US Preventive Services Task Force (USPSTF) members: Feinstein Institutes for Medical Research at Northwell Health, Manhasset, New York (Davidson); Harvard Medical School, Boston, Massachusetts (Barry); University of California, Los Angeles (Mangione); Albert Einstein College of Medicine, New York, New York (Cabana); Virginia Commonwealth University, Richmond (Chelmow, Krist); University of Washington, Seattle (Coker); University of Pittsburgh, Pittsburgh, Pennsylvania (Davis); University of North Carolina at Chapel Hill (Donahue); University of Texas Health Science Center, San Antonio (Jaén); Fairfax Family Practice Residency, Fairfax, Virginia (Krist); George Mason University, Fairfax, Virginia (Kubik); University of Virginia, Charlottesville (Li); New York University, New York, New York (Ogedegbe); University of Massachusetts Medical School, Worcester (Pbert); University of Arizona, Tucson (Ruiz); University of Missouri, Columbia (Stevermer); University of Hawaii, Honolulu (Tseng); Tufts University School of Medicine, Boston, Massachusetts (Wong).

Author Contributions: Dr Davidson had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. The USPSTF members contributed equally to the recommendation statement.

Conflict of Interest Disclosures: Authors followed the policy regarding conflicts of interest described at https://www.uspreventiveservicestaskforce.org/Page/Name/conflict-of-interest-disclosures. All members of the USPSTF receive travel reimbursement and an honorarium for participating in USPSTF meetings.

Funding/Support: The USPSTF is an independent, voluntary body. The US Congress mandates that the Agency for Healthcare Research and Quality (AHRQ) support the operations of the USPSTF.

Role of the Funder/Sponsor: AHRQ staff assisted in the following: development and review of the research plan, commission of the systematic evidence review from an Evidence-based Practice Center, coordination of expert review and public comment of the draft evidence report and draft recommendation statement, and the writing and preparation of the final recommendation statement and its submission for publication. AHRQ staff had no role in the approval of the final recommendation statement or the decision to submit for publication.

Disclaimer: Recommendations made by the USPSTF are independent of the US government. They should not be construed as an official position of AHRQ or the US Department of Health and Human Services.

Additional Contributions: We thank Howard Tracer, MD (AHRQ), who contributed to the writing of the manuscript, and Lisa Nicolella, MA (AHRQ), who assisted with coordination and editing.

Additional Information: The US Preventive Services Task Force (USPSTF) makes recommendations about the effectiveness of specific preventive care services for patients without obvious related signs or symptoms. It bases its recommendations on the evidence of both the benefits and harms of the service and an assessment of the balance. The USPSTF does not consider the costs of providing a service in this assessment. The USPSTF recognizes that clinical decisions involve more considerations than evidence alone. Clinicians should understand the evidence but individualize decision-making to the specific patient or situation. Similarly, the USPSTF notes that policy and coverage decisions involve considerations in addition to the evidence of clinical benefits and harms. Similarly, the USPSTF notes that policy and coverage decisions involve considerations in addition to the evidence of clinical benefits and harms. Published by JAMA®—Journal of the American Medical Association under arrangement with the Agency for Healthcare Research and Quality (AHRQ). ©2022 AMA and United States Government, as represented by the Secretary of the Department of Health and Human Services (HHS), by assignment from the members of the United States Preventive Services Task Force (USPSTF). All rights reserved.

References
1.
Heron  M .  Deaths: leading causes for 2017.   Natl Vital Stat Rep. 2019;68(6):1-77.PubMedGoogle Scholar
2.
Virani  SS , Alonso  A , Aparicio  HJ ,  et al; American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee.  Heart disease and stroke statistics—2021 update: a report from the American Heart Association.   Circulation. 2021;143(8):e254-e743. doi:10.1161/CIR.0000000000000950PubMedGoogle ScholarCrossref
3.
US Preventive Services Task Force. US Preventive Services Task Force Procedure Manual. Published 2021. Accessed March 8, 2022. https://uspreventiveservicestaskforce.org/uspstf/about-uspstf/methods-and-processes/procedure-manual
4.
Goff  DC  Jr , Lloyd-Jones  DM , Bennett  G ,  et al.  2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.   J Am Coll Cardiol. 2014;63(25, pt B):2935-2959. doi:10.1016/j.jacc.2013.11.005PubMedGoogle ScholarCrossref
5.
DeFilippis  AP , Young  R , Carrubba  CJ ,  et al.  An analysis of calibration and discrimination among multiple cardiovascular risk scores in a modern multiethnic cohort.   Ann Intern Med. 2015;162(4):266-275. doi:10.7326/M14-1281PubMedGoogle ScholarCrossref
6.
Cook  NR , Ridker  PM .  Calibration of the pooled cohort equations for atherosclerotic cardiovascular disease: an update.   Ann Intern Med. 2016;165(11):786-794. doi:10.7326/M16-1739PubMedGoogle ScholarCrossref
7.
Rana  JS , Tabada  GH , Solomon  MD ,  et al.  Accuracy of the atherosclerotic cardiovascular risk equation in a large contemporary, multiethnic population.   J Am Coll Cardiol. 2016;67(18):2118-2130. doi:10.1016/j.jacc.2016.02.055PubMedGoogle ScholarCrossref
8.
Dalton  JE , Perzynski  AT , Zidar  DA ,  et al.  Accuracy of cardiovascular risk prediction varies by neighborhood socioeconomic position: a retrospective cohort study.   Ann Intern Med. 2017;167(7):456-464. doi:10.7326/M16-2543PubMedGoogle ScholarCrossref
9.
Colantonio  LD , Richman  JS , Carson  AP ,  et al.  Performance of the atherosclerotic cardiovascular disease pooled cohort risk equations by social deprivation status.   J Am Heart Assoc. 2017;6(3):e005676. doi:10.1161/JAHA.117.005676PubMedGoogle ScholarCrossref
10.
Baigent  C , Blackwell  L , Collins  R ,  et al; Antithrombotic Trialists’ (ATT) Collaboration.  Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials.   Lancet. 2009;373(9678):1849-1860. doi:10.1016/S0140-6736(09)60503-1PubMedGoogle ScholarCrossref
11.
De Berardis  G , Lucisano  G , D’Ettorre  A ,  et al.  Association of aspirin use with major bleeding in patients with and without diabetes.   JAMA. 2012;307(21):2286-2294. doi:10.1001/jama.2012.5034PubMedGoogle ScholarCrossref
12.
Selak  V , Jackson  R , Poppe  K ,  et al.  Predicting bleeding risk to guide aspirin use for the primary prevention of cardiovascular disease: a cohort study.   Ann Intern Med. 2019;170(6):357-368. doi:10.7326/M18-2808PubMedGoogle ScholarCrossref
13.
de Groot  NL , Hagenaars  MP , Smeets  HM , Steyerberg  EW , Siersema  PD , van Oijen  MG .  Primary non-variceal upper gastrointestinal bleeding in NSAID and low-dose aspirin users: development and validation of risk scores for either medication in two large Dutch cohorts.   J Gastroenterol. 2014;49(2):245-253. doi:10.1007/s00535-013-0817-yPubMedGoogle ScholarCrossref
14.
Guirguis-Blake  JM , Evans  CV , Perdue  LA , Bean  SI , Senger  CA .  Aspirin Use to Prevent Cardiovascular Disease and Colorectal Cancer: An Evidence Update for the US Preventive Services Task Force. Evidence Synthesis No. 211. Agency for Healthcare Research and Quality; 2022. AHRQ publication 21-05283-EF-1.
15.
US Preventive Services Task Force.  Statin use for the primary prevention of cardiovascular disease in adults: US Preventive Services Task Force recommendation statement.   JAMA. 2016;316(19):1997-2007. doi:10.1001/jama.2016.15450PubMedGoogle ScholarCrossref
16.
US Preventive Services Task Force.  Interventions for tobacco smoking cessation in adults, including pregnant persons: US Preventive Services Task Force recommendation statement.   JAMA. 2021;325(3):265-279. doi:10.1001/jama.2020.25019PubMedGoogle ScholarCrossref
17.
US Preventive Services Task Force.  Behavioral counseling interventions to promote a healthy diet and physical activity for cardiovascular disease prevention in adults with cardiovascular risk factors: US Preventive Services Task Force recommendation statement.   JAMA. 2020;324(20):2069-2075. doi:10.1001/jama.2020.21749PubMedGoogle ScholarCrossref
18.
US Preventive Services Task Force.  Behavioral counseling to promote a healthful diet and physical activity for cardiovascular disease prevention in adults without cardiovascular risk factors: US Preventive Services Task Force recommendation statement.   JAMA. 2017;318(2):167-174. doi:10.1001/jama.2017.7171PubMedGoogle ScholarCrossref
19.
US Preventive Services Task Force.  Behavioral weight loss interventions to prevent obesity-related morbidity and mortality in adults: US Preventive Services Task Force recommendation statement.   JAMA. 2018;320(11):1163-1171. doi:10.1001/jama.2018.13022PubMedGoogle ScholarCrossref
20.
US Preventive Services Task Force.  Screening for hypertension in adults: US Preventive Services Task Force reaffirmation recommendation statement.   JAMA. 2021;325(16):1650-1656. doi:10.1001/jama.2021.4987PubMedGoogle ScholarCrossref
21.
US Preventive Services Task Force.  Screening for prediabetes and type 2 diabetes: US Preventive Services Task Force recommendation statement.   JAMA. 2021;326(8):736-743. doi:10.1001/jama.2021.12531PubMedGoogle ScholarCrossref
22.
US Preventive Services Task Force.  Screening for colorectal cancer: US Preventive Services Task Force recommendation statement.   JAMA. 2021;325(19):1965-1977. doi:10.1001/jama.2021.6238PubMedGoogle ScholarCrossref
23.
Bibbins-Domingo  K ; US Preventive Services Task Force.  Aspirin use for the primary prevention of cardiovascular disease and colorectal cancer: US Preventive Services Task Force recommendation statement.   Ann Intern Med. 2016;164(12):836-845. doi:10.7326/M16-0577PubMedGoogle ScholarCrossref
24.
McNeil  JJ , Wolfe  R , Woods  RL ,  et al; ASPREE Investigator Group.  Effect of aspirin on cardiovascular events and bleeding in the healthy elderly.   N Engl J Med. 2018;379(16):1509-1518. doi:10.1056/NEJMoa1805819PubMedGoogle ScholarCrossref
25.
Guirguis-Blake  JM , Evans  CV , Perdue  LA , Bean  SI , Senger  CA .  Aspirin use to prevent cardiovascular disease and colorectal cancer: updated evidence report and systematic review for the US Preventive Services Task Force.   JAMA. Published April 26, 2022. doi:10.1001/jama.2022.3337Google Scholar
26.
Dehmer  SP , O’Keefe  LR , Grossman  ES , Maciosek  MV .  Aspirin Use to Prevent Cardiovascular Disease and Colorectal Cancer: An Updated Decision Analysis for the US Preventive Services Task Force. Agency for Healthcare Research and Quality; 2022. AHRQ publication 21-05283-EF-2.
27.
Dehmer  SP , O’Keefe  LR , Evans  CV , Guirguis-Blake  JM , Perdue  LA , Maciosek  MV .  Aspirin use to prevent cardiovascular disease and colorectal cancer: updated modeling study for the US Preventive Services Task Force.   JAMA. Published April 26, 2022. doi:10.1001/jama.2022.3385Google Scholar
28.
Steering Committee of the Physicians’ Health Study Research Group.  Final report on the aspirin component of the ongoing Physicians’ Health Study.   N Engl J Med. 1989;321(3):129-135. doi:10.1056/NEJM198907203210301PubMedGoogle ScholarCrossref
29.
Cook  NR , Lee  IM , Zhang  SM , Moorthy  MV , Buring  JE .  Alternate-day, low-dose aspirin and cancer risk: long-term observational follow-up of a randomized trial.   Ann Intern Med. 2013;159(2):77-85. doi:10.7326/0003-4819-159-2-201307160-00002PubMedGoogle ScholarCrossref
30.
 Thrombosis prevention trial: randomised trial of low-intensity oral anticoagulation with warfarin and low-dose aspirin in the primary prevention of ischaemic heart disease in men at increased risk: the Medical Research Council’s General Practice Research Framework.   Lancet. 1998;351(9098):233-241. doi:10.1016/S0140-6736(97)11475-1PubMedGoogle ScholarCrossref
31.
Rothwell  PM , Wilson  M , Elwin  CE ,  et al.  Long-term effect of aspirin on colorectal cancer incidence and mortality: 20-year follow-up of five randomised trials.   Lancet. 2010;376(9754):1741-1750. doi:10.1016/S0140-6736(10)61543-7PubMedGoogle ScholarCrossref
32.
Virani  SS , Alonso  A , Benjamin  EJ ,  et al; American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee.  Heart disease and stroke statistics—2020 update: a report from the American Heart Association.   Circulation. 2020;141(9):e139-e596. doi:10.1161/CIR.0000000000000757PubMedGoogle ScholarCrossref
33.
Wallace  JL .  Prostaglandins, NSAIDs, and gastric mucosal protection: why doesn’t the stomach digest itself?   Physiol Rev. 2008;88(4):1547-1565. doi:10.1152/physrev.00004.2008PubMedGoogle ScholarCrossref
34.
Nemerovski  CW , Salinitri  FD , Morbitzer  KA , Moser  LR .  Aspirin for primary prevention of cardiovascular disease events.   Pharmacotherapy. 2012;32(11):1020-1035. doi:10.1002/phar.1127PubMedGoogle ScholarCrossref
35.
Arnett  DK , Blumenthal  RS , Albert  MA ,  et al.  2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.   Circulation. 2019;140(11):e596-e646. doi:10.1161/CIR.0000000000000678PubMedGoogle ScholarCrossref
36.
American Academy of Family Physicians. Clinical preventive service recommendations: aspirin use to prevent CVD and colorectal cancer. Accessed March 8, 2022. https://www.aafp.org/family-physician/patient-care/clinical-recommendations/all-clinical-recommendations/aspirin-use-prevention.html
Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
Close
Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close

Name Your Search

Save Search
Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Close

Lookup An Activity

or

Close

My Saved Searches

You currently have no searches saved.

Close

My Saved Courses

You currently have no courses saved.

Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close