Aspirin for primary prevention of cardiovascular disease: What do the current USPSTF guidelines say?

Article Figures & Data

TABLE 1

Summary of 3 large trials on daily aspirin therapy for primary prevention

Trial	Population	Findings
ASCEND⁴	15,480 patients with diabetes and no prior CVD history	Therapy resulted in a 12% reduction in myocardial infarction and ischemic stroke Therapy resulted in a 30% increased risk for a major bleeding event, especially prominent in patients age 60 or older
ARRIVE⁵	12,546 patients with mean 17% 10-year CVD risk	No significant benefit in CVD prevention with therapy compared with placebo Twofold increase in gastrointestinal bleeding seen in aspirin therapy group
ASPREE^6,7	19,114 patients, average age 74	Therapy provided no benefit in preventing first nonfatal cardiovascular event or death Therapy showed a 30% increased risk of major nonfatal hemorrhage, particularly in upper-gastrointestinal bleeds and intracranial hemorrhage

ARRIVE = Aspirin to Reduce Risk of Initial Vascular Events; ASCEND = A Study of Cardiovascular Events in Diabetes; ASPREE = Aspirin in Reducing Events in the Elderly; CVD = cardiovascular disease

TABLE 2

A comparison of the 2022 USPSTF and 2019 ACC/AHA guidelines for daily aspirin use for primary prevention, by age

	Age 40 to 60	Age 60 to 70	Age > 70
USPSTF 2022¹	Individualize for risk > 10% for CVD events using pooled cohort equation (grade C)	No aspirin (grade D)	No aspirin (grade D)
ACC/AHA 2019¹⁰	Individualize for higher risk patients (COR IIb/LOE A)	Individualize for higher risk patients (COR IIb/LOE A)	No aspirin (COR III/LOE B-R)

ACC = American College of Cardiology; AHA = American Heart Association; COR = class of recommendation; COR IIb/LOE A = high-quality evidence showing treatment may be reasonable, but effectiveness is not well established; COR III/LOE B-R = moderate-quality evidence showed no benefit and potential harm; CVD = cardiovascular disease; grade C = small benefit in select patients; grade D = no net benefit or harm outweighs benefit; LOE = level of evidence