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Press Release Date: January 14, 2002
The U.S. Preventive Services Task Force (USPSTF) today strongly recommended that clinicians discuss the benefits and harms of aspirin therapy with healthy adult patients who are at increased risk of coronary heart disease (CHD), primarily heart attacks. The USPSTF recommendation will be published in the January 15, 2002, issue of the Annals of Internal Medicine.
Recent studies reviewed by the USPSTF found that regular use of aspirin reduced the risk of CHD by 28 percent in persons who had never had a heart attack or stroke but who were at increased risk. Those considered at increased risk for CHD are men over the age of 40, post-menopausal women, and younger persons with risk factors for CHD, (e.g., smoking, diabetes, hypertension). Every year, more than 1 million Americans die from heart attacks and other forms of CHD.
In addition to its benefits, the Task Force also noted that aspirin can have serious side effects. Aspirin may increase the incidence of gastrointestinal bleeding and cause a small increase in the incidence of hemorrhagic strokes, which involve bleeding in the brain. Although the benefits of aspirin outweigh the harms for persons with an increased risk of CHD, the harms may exceed the benefits for those who are at average or low risk for heart disease. Rather than starting to take aspirin on their own, patients should discuss these risks and benefits with their health care professional.
"Aspirin therapy is powerful, and clinicians and patients need to discuss the role of aspirin therapy in combating CHD," said John M. Eisenberg, M.D., director of the Agency for Healthcare Research and Quality (AHRQ), which sponsors the USPSTF. "This recommendation presents an ideal opportunity for clinicians to work with patients to determine the most appropriate preventive therapy."
Discussions about aspirin should take into account a patient's overall risk of heart disease. This can be estimated by assessing a patient's age, sex, blood pressure, cholesterol levels, and information on whether they smoke or have diabetes. The Internet offers several easy-to-use, free calculators that individuals can use to determine levels of cardiovascular risk over a 5-or-10-year period. Examples are http://hin.nhlbi.nih.gov/atpiii/calculator.asp and http://www.med-decisions.com.
The USPSTF considers a 5-year risk of 3 percent or more (meaning that 3 people in 100 will have a heart attack within the coming 5 years if they do not undertake any kind of preventive therapy) as increased risk. The balance of benefits and harms of aspirin is the most positive among this group.
The USPSTF, a panel of independent, private-sector experts in prevention and primary care, based its conclusion on a report by the Evidence-based Practice Center at RTI (Research Triangle Park, NC) and the University of North Carolina (Chapel Hill) School of Medicine. Aspirin for the Primary Prevention of Cardiovascular Events is the sixth recommendation that the current USPSTF has released.
Working with the Evidence-based Practice Center, the USPSTF conducts rigorous, impartial assessments of scientific evidence for a broad range of preventive services. It grades the strength of evidence from "A" (strongly recommends) to "D" (recommends against). An "I" recommendation, in which the USPSTF finds insufficient evidence to recommend for or against a particular intervention, means that the evidence that the service is effective is lacking, of poor quality, or conflicting, and the balance of harms and benefits cannot be determined. The aspirin recommendation is a grade "A," or "strongly recommend."
To help clinicians apply Task Force recommendations in practice and to help patients understand which clinical preventive services they should expect clinicians to provide, AHRQ sponsors the Put Prevention Into Practice (PPIP) program. Select to access information about the PPIP program and products, and a list of other USPSTF products under review.
Editor's Note: In addition to the USPSTF recommendation, the Annals of Internal Medicine will publish a separate article based on the report of the evidence on aspirin for primary prevention of CHD produced by RTI (Research Triangle Park, NC) and the University of North Carolina (Chapel Hill) School of Medicine Evidence-based Practice Center in its January 15, 2002, issue.
Audio news releases (ANRs) in English and Spanish on the aspirin recommendation will be available for download beginning at 5:00 p.m. on Monday, January 14, 2002. The English ANR will include an actuality from Dr. Cynthia Mulrow, Clinical Professor, Department of Medicine, University of Texas Health Science Center, San Antonio; the Spanish ANR will include an actuality from Karen Migdail, spokesperson for AHRQ. Each ANR will be available in MP3 and Real Audio formats and will include the script.
For more information, please contact Farah Englert, (301) 427-1865.