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US experts promote aspirin for primary CVD prevention

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US public health experts have recommended that middle-aged people at increased risk of cardiovascular disease consider taking aspirin for primary prevention of CVD and colorectal cancer.

New guidance recommends initiating low-dose aspirin for the primary prevention of CVD and colorectal cancer in adults aged 50-59 years who have a 10% or greater 10-year CVD risk and are not at increased risk for bleeding.

The recommendation comes from the independent US Preventive Services Task Force, which reviewed over 3,000 studies to evaluate whether or not taking aspirin decreases the risk of developing CVD in adults aged 40 and over.

The review, published in Annals of Internal Medicine, was based on three systematic evidence reviews and a modelling paper.

The three reviews affirmed evidence of aspirin’s effectiveness for both sexes in preventing first-time myocardial infarction and ischemic stroke and also found new evidence indicating aspirin’s effectiveness in preventing colorectal cancer, said the taskforce.

“For people without CVD, the risk of side effects and increased bleeding far outweighs the potential benefit”

Emily Reeve

The updated reviews also reaffirmed aspirin’s role in increasing the risk for major gastrointestinal bleeding and hemorrhagic stroke.

But modelling by the reviewers suggested that aspirin use would improve overall quality of life, or reduce illness, for most men and women without elevated bleeding risk when initiated between the ages of 40 and 69 years for lifetime use.

Such use would improve life expectancy for most men and women who start aspirin between the ages of 40 and 59 years and for those at higher risk for CVD who start between the ages of 60 and 69, they said.

However, the taskforce noted that more research was needed to assess whether taking aspirin is beneficial for people who are younger than 50 or 70 years and older.

Emily Reeve, senior cardiac nurse at the British Heart Foundation, backed the use of aspirin for the secondary prevention of CVD but questioned its use for primary prevention.

“Previous studies have shown the benefit of taking aspirin as a way to help prevent another heart episode in the future,” she said.

“However, for people without cardiovascular disease, the risk of side effects and increased bleeding far outweighs the potential benefit of taking aspirin,” he added.

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