Aspirin for the Prevention of Heart Attacks in People without Previous Cardiovascular Events: Recommendations from the United States Preventive Services Task Force

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The summary below is from the full reports titled "Aspirin for the Primary Prevention of Cardiovascular Events: Recommendation and Rationale" and "Aspirin for the Primary Prevention of Cardiovascular Events: A Summary of the Evidence for the U.S. Preventive Services Task Force." They are in the 15 January 2002 issue of Annals of Internal Medicine (volume 136, pages 157-160 and pages 161-172). The first report was written by the U.S. Preventive Services Task Force; the second report was written by M Hayden, M Pignone, C Phillips, and C Mulrow.

What is the United States Preventive Services Task Force?

The United States Preventive Services Task Force (USPSTF) is a group of health experts that reviews published research and makes recommendations about preventive health care.

What is the problem and what is known about it so far?

Heart attack ("myocardial infarction") occurs when blockage develops in the blood vessels that supply the heart muscle. Heart attacks are one of the most common causes of illness and are the leading cause of death in the United States. Certain conditions ("risk factors") increase a person's chance of having a heart attack. They include older age, male sex, high blood pressure, diabetes, smoking, high total or LDL ("bad") cholesterol levels, low HDL ("good") cholesterol levels, and close relatives with heart attacks before age 60. Aspirin decreases the chances of a heart attack in people who have had previous heart attacks or strokes, but its usefulness in people without such a history is unclear. Aspirin can have uncommon but serious complications, such as bleeding in the digestive tract or in the brain.

How did the USPSTF develop these recommendations?

The USPSTF reviewed published research to measure the benefits and harms of aspirin use in adults who have never had a heart attack or stroke.

What did the authors find?

There is good evidence that aspirin decreases heart attacks in people who do not have cardiovascular disease but do have heart attack risk factors. The more risk factors a person has, the more heart attacks aspirin prevents. However, taking aspirin increases a person's chances of complications, such as bleeding in the digestive tract or brain. Complications are most likely in people who have uncontrolled high blood pressure or who take blood thinners or anti-inflammatory drugs in addition to aspirin.

What does the USPSTF suggest that patients do?

Adult patients who have cardiovascular risk factors should discuss the benefits and harms of aspirin to prevent cardiovascular events with their doctors. Patients and doctors can use a tool located at http://www.med-decisions.com to calculate a person's risk of a future heart attack. If a patient's chance of having a heart attack over the next 5 years is at least 3 out of 100 (3%), then the benefits of aspirin are likely to outweigh the harms. However, there is no single correct answer for all patients. The decision to take aspirin or not will depend on the patient's feelings about avoiding heart attacks while risking the possible complications of bleeding in the digestive tract or brain.

What are the cautions related to these recommendations?

Participants in the studies that the USPSTF used to develop the recommendations were mostly men who were 40 to 75 years of age. Estimates of benefits and harms may not be reliable for women or for older men.