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U.S. Preventive Services Task Force urges clinicians and patients to discuss aspirin therapy

The U.S. Preventive Services Task Force (USPSTF) has issued a strong recommendation 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 appears 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 people 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, postmenopausal women, and younger people 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 people who have 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 providers.

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 can be found at 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 Institute) and the University of North Carolina (Chapel Hill) School of Medicine. Aspirin for the Primary Prevention of Cardiovascular Events is the sixth recommendation to be released by the current USPSTF.

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 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 for more information about the PPIP program and products and a list of other USPSTF products under review.

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