USPSTF Backs Aspirin for CVD, Colon Cancer Prevention

Low-dose aspirin was recommended for primary prevention of both cardiovascular disease and colorectal cancer for 50- to 59-year-olds by the U.S. Preventive Services Task Force (USPSTF).

The draft recommendation applied to only people at 10% or greater 10-year cardiovascular disease risk who aren't at increased risk for bleeding and who are willing to take low-dose aspirin daily for at least 10 years and expect to live that long.

For people ages 60 to 69, those at greater than 10% 10-year cardiovascular disease risk might get a small net benefit but should consider use on an individual basis, the USPSTF group suggested, giving it a "C" recommendation.

Use before age 50 or after 69 had insufficient evidence for recommendation, the group reported.

The group previously supported aspirin for cardiovascular disease prevention in a broader age range and discouraged aspirin for colorectal cancer prevention in separate recommendations.

Some risk factors for cancer can be avoided, but many cannot. For example, both smoking and inheriting certain genes are risk factors for some types of cancer, but only smoking can be avoided. Regular exercise and a healthy diet may be protective factors for some types of cancer. Avoiding risk factors and increasing protective factors may lower your risk, but it does not mean that you will not get cancer.

Different ways to prevent cancer are being studied, including:

Changing lifestyle or eating habits.
Avoiding things known to cause cancer.
Taking medicines to treat a precancerous condition or to keep cancer from starting.

The integrated approach accounting also for bleeding should help in the clinic, "because, in fact, the decision faced by a doctor and a patient is 'Should I take aspirin?'" Kirsten Bibbins-Domingo, MD, PhD, of the University of California San Francisco and co-vice-chair of the USPSTF, said in an interview.

But Deirdre J. Mattina, MD, a cardiologist at Henry Ford Hospital in Detroit, disagreed, saying the new guidance "adds more complexity and confusion" instead of simplifying decisions.

"I actually think there isn't added value in combining two vastly different indications for primary prevention aspirin under the same recommendation guideline," she told MedPage Today. "As a practicing cardiologist, we already have a lot of controversy in the data that exists for the use of primary prevention aspirin for cardiovascular disease outcomes."

"I strongly disagree with the recommendations. In fact, so does the FDA," said Steven Nissen, MD, chair of cardiovascular medicine at the Cleveland Clinic.