MEDIA RELEASE
20th March 2009
US experts recommend aspirin to prevent first heart attack or
stroke
Aspirin should be recommended to reduce the risk of heart attack
in men aged 45 - 79 and to reduce the risk of stroke in women
aged 55 - 79 who do not have heart disease, the US Preventive
Services Task Force (USPSTF) has recommended.1
The USPSTF2 states that men aged 45 - 79 should be encouraged
to take aspirin when the potential benefit of a reduction in the
risk of a heart attack outweighs the potential harm of an increase
in gastrointestinal bleeding; women aged 55 - 79 should be encouraged
to take aspirin when the potential benefit of a reduction in the
risk of ischaemic stroke outweighs the potential harm of an increase
in gastrointestinal bleeding.
The recommendations are based on the latest evidence of the benefits
of aspirin. If implemented in Europe, they would greatly increase
the number of people taking aspirin to prevent heart attack or
stroke.
Taking aspirin to prevent heart attack or stroke by people who
are not known to have heart disease is known as primary prevention.
An individual’s risk is estimated from their sex, age, smoking
status, blood pressure and cholesterol level. European guidelines
recommend primary prevention with aspirin when the risk of a heart
attack exceeds 10% per year;3 in the UK, primary prevention is
recommended for people over 50 years old when the 10-year risk
exceeds 20%.4 Aspirin is universally recommended for people who
have already had a heart attack or stroke (secondary prevention).
The USPSTF provides estimates of the numbers of cardiovascular
events avoided by primary prevention with aspirin and the risk
of gastrointestinal bleeding and stroke. Assuming aspirin reduces
heart attacks by 32%, its benefits for men aged 45 - 79 outweigh
the risks when the 10-year risk of a heart attack is 4%. For women
aged 55 - 59, the benefit:risk ratio becomes favourable when the
10-year risk of stroke is 3%. The USPSFT says the benefits of
aspirin are not proven for men or women in younger age groups,
among people aged 80 or over, or for reducing the risk of heart
attack among women.1
The decision to take aspirin should be made jointly between doctors
and patients, the USPSFT emphasises, but the recommendation should
be stronger as the potential benefit increases.
References
1. US Preventive Services Task Force. Aspirin for the Prevention
of Cardiovascular Disease: U.S. Preventive Services Task Force
Recommendation Statement. Ann Intern Med 2009;150:393-404 (www.annals.org/cgi/content/full/150/6/396;
accessed 18.3.09)
2. The USPSTF is an independent, voluntary body. It makes recommendations
about preventive care services for patients without recognized
signs or symptoms of the target condition, basing its recommendations
on a systematic review of the evidence of the benefits and harms
and an assessment of the net benefit of the service.
3. Fourth Joint Task Force of the European Society of Cardiology
and other societies on cardiovascular disease prevention in clinical
practice. European guidelines on cardiovascular disease prevention
in clinical practice. Eur J Cardiovasc Prev Rehab 2007;14 (suppl.
2):E1-E40 (www.escardio.org/guidelines-surveys/esc-guidelines/GuidelinesDocuments/guidelines-CVD-prevention-ES-FT.pdf;
accessed 18.3.09)
4. Joint Formulary Committee. Hypertension and heart failure.
Other measures to reduce cardiovascular risk. British National
Formulary No. 57. March 2009 (www.bnf.org.uk/bnf/bnf/current/2534.htm;
accessed 18.3.09)
