Those at risk include people with unfavorable cholesterol levels (elevated total cholesterol levels and/or low levels of high-density lipoprotein cholesterol), men over age 40, postmenopausal women, and people with risk factors for CHD, such as smoking, diabetes, and hypertension.
It is known that aspirin decreases the chances of heart attacks in people who have had previous heart attacks or strokes.
The new recommendations and a background article, with a systematic review of the evidence about the harms and benefits of aspirin therapy, are published in the latest issue of the Annals of Internal Medicine.
The optimum dose of aspirin for prevention is not known, according to the USPSTF. Doses of 75 mg daily, approximately the dose in one 'baby' aspirin, appear as effective as higher doses.
Uncontrolled hypertension may lessen the benefits of aspirin in reducing CHD.
However, the Task Force pointed out aspirin's potential harmful effects.
It found good evidence that aspirin increases the incidence of gastrointestinal bleeding and found fair evidence that aspirin increases the incidence of hemorrhagic strokes.
Although the benefits of aspirin outweigh the harms for persons with an increased risk of CHD, the harms may exceed the benefits for those at low risk of CHD.
| Aspirin recommended in those with ≥ 3% risk of heart attack within 5 years.
| Annals of Internal Medicine |
As patients may have different views, physicians should discuss the benefits and harms of aspirin with each patient before deciding to use aspirin to prevent heart attacks.
Assessing a person's age, sex, blood pressure, cholesterol levels, and whether he or she smokes or has diabetes can estimate overall risk for coronary heart disease.
The balance of benefits and harms of aspirin for preventing CHD shifts toward benefit with increasing risk for CHD.
The benefits of aspirin are clearest for those who have 3% or greater chance of suffering a heart attack within 5 years, according to the USPSTF.
"Aspirin therapy is powerful, and clinicians and patients need to discuss the role of aspirin therapy in combating CHD," said John M. Eisenberg, 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 therapy."