Aspirin for primary prevention: Recommendations from major societies
| American Heart Association/American College of Cardiology, 20027 |
| Low-dose aspirin recommended in persons at higher cardiovascular risk, especially those with 1-year risk > 10% |
| Low-dose aspirin recommended in patients with diabetes at increased cardiovascular risk, including those who are over age 40 or who have additional risk factors |
| Therapy should not be recommended for patients with diabetes under age 21 because of the increased risk of Reye syndrome associated with aspirin use in this population; patients with diabetes under age 30 have not been studied |
| European Society of Cardiology, 20166 |
| Antiplatelet therapy is not recommended in individuals without cardiovascular disease due to the increased risk of major bleeding |
| Antiplatelet therapy (eg, aspirin) is not recommended for people with diabetes who do not have cardiovascular disease |
| US Preventive Services Task Force, 201734 |
| Low-dose aspirin is recommended in adults ages 50-59 who have a > 10% 10-year risk, are not at increased risk for bleeding, have a life expectancy of > 10 years, and are willing to take it daily for > 10 years |
| The decision to initiate low-dose aspirin for primary prevention of cardiovascular disease and colorectal cancer in adults ages60-69 who have a 10% or greater 10-year cardiovascular disease risk should be an individual one |
| The current evidence is insufficient to assess the balance of benefits and harms of initiating aspirin use for the primary prevention of cardiovascular disease and colorectal cancer in adults under age 50 |
| The current evidence is insufficient to assess the balance of benefits and harms of initiating aspirin use for primary prevention of cardiovascular disease and colorectal cancer in adults age 70 or older |
| American Academy of Family Physicians, 201633 |
| Low-dose aspirin use for primary prevention of cardiovascular disease and colorectal cancer is recommended in adults ages 50-59 who have a 10% or greater 10-year cardiovascular disease risk, are not at increased risk for bleeding, have a life expectancy of at least 10 years, and are willing to take low-dose aspirin daily for at least 10 years |
| The decision to initiate low-dose aspirin use for the primary prevention of cardiovascular disease and colorectal cancer in adults ages 60-69 who have a 10% or greater 10-year cardiovascular disease risk should be an individual one |
| Evidence is insufficient to assess risk-benefit profile of aspirin for primary prevention of cardiovascular disease and colorectal cancer in adults younger than 50 |
| The current evidence is insufficient to assess the balance of benefits and harms of starting aspirin for primary prevention of cardiovascular disease and colorectal cancer in adults age 70 or older |
| American Diabetes Association, 201832 |
| Low-dose aspirin may be considered as a primary prevention strategy in those with type 1 or type 2 diabetes who are at increased cardiovascular risk; this includes most men and women with diabetes age > 50 who have at least 1 additional major risk factor and are not at increased risk of bleeding |
| American Heart Association/American College of Cardiology, 201913 |
| Low-dose aspirin might be considered for the primary prevention of atherosclerotic cardiovascular disease (ASCVD) among select adults ages 40-70 who are at higher ASCVD risk but not at increased bleeding risk |
| Low-dose aspirin should not be prescribed on a routine basis for primary prevention of ASCVD among adults age > 70 |
| Low-dose aspirin should not be prescribed for primary prevention of ASCVD among adults of any age who are at increased risk of bleeding |