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Annals of Internal Medicine Tip Sheet
April 12, 2016


Below is information about articles being published in Annals of Internal Medicine. The information is not intended to substitute for the full article as a source of information. Annals of Internal Medicine attribution is required for all coverage.


1. USPSTF publishes recommendations on taking aspirin to prevent heart attack, stroke, and colorectal cancer

Free content: www.annals.org/article.aspx?doi=10.7326/M16-0577

The U.S. Preventive Services Task Force (USPSTF) recommends that people who are 50-69 years old, have increased risk of cardiovascular disease (CVD), and who are not at increased risk for bleeding, consider taking aspirin for primary prevention of CVD and colorectal cancer. The full recommendation and evidence reviews are published in Annals of Internal Medicine.

The USPSTF recommends initiating low-dose aspirin use for the primary prevention of CVD and colorectal cancer in adults aged 50 to 59 years who have a 10 percent or greater 10-year CVD 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. This is a B recommendation.

The decision to initiate low-dose aspirin use for the primary prevention of CVD and colorectal cancer in adults aged 60 to 69 years who have a 10 percent or greater 10-year CVD risk should be an individual one with his or her doctor. Those who 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 are more likely to benefit. This is a C recommendation.

CVD and colorectal cancer are major causes of death for adults in the U.S. In fact, in 2011 over half of all deaths in the U.S. were caused by heart disease, cancer or stroke. Colorectal cancer is the third most commonly diagnosed cancer in men and women and a leading cause of cancer death.

While taking low-dose aspirin daily can help prevent heart attacks, stroke and cancer, it also increases the risk of serious harms, particularly risk of bleeding in the stomach and intestines, and strokes caused by bleeding in the brain. The Task Force looked at the combined benefits and harms of taking aspirin for the primary prevention of both cardiovascular disease and colorectal cancer in this recommendation.

More research is needed to assess whether taking aspirin is beneficial for people who are younger than 50 or 70 years and older.

2. Benefits of regular aspirin use outweigh harms for some patients, including those at high risk for cardiovascular disease

Abstract: www.annals.org/article.aspx?doi=10.7326/M15-2129

The U.S. Preventive Services Task Force (USPSTF) concluded that the benefits of regular aspirin use for the primary prevention of cardiovascular disease (CVD) and colorectal cancer can outweigh the bleeding risks for some patients, including those with higher risk for CVD. The recommendation was informed by three systematic evidence reviews and a modeling paper, all published in Annals of Internal Medicine.

Three recent systematic reviews conducted on behalf of the USPSTF reaffirmed evidence of aspirin’s effectiveness for both sexes in preventing first-time myocardial infarction and ischemic stroke (Aspirin for the Primary Prevention of Cardiovascular Events) and also found new evidence indicating aspirin’s effectiveness in preventing colorectal cancer (Aspirin for the Prevention of Cancer Incidence and Mortality). However, the updated reviews also reaffirm aspirin’s role in increasing the risk for major gastrointestinal bleeding and hemorrhagic stroke (Bleeding Risks with Aspirin Use for Primary Prevention in Adults). These findings create a challenge for physicians who must determine the appropriateness of regular aspirin use for their patients. To further inform and clarify its recommendation, the USPSTF commissioned a decision analysis using a simulation modeling assessing the expected net benefit of aspirin use across clinically relevant population groups defined by their age, sex and risk for CVD.

The model suggests 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. For older patients with a lower risk for CVD, the benefits of aspirin use do not seem to outweigh the potential harms. Because of limited primary evidence about people younger than 50, the USPSTF concluded there was not enough certainty to make a recommendation for this age group.

As with all of its recommendations and reviews, the USPSTF recommends that patient preferences should be considered and that physicians should engage in shared decision-making.

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