New Task Force Recommendations Call for Aspirin Use
by Older People Up to Age 80
Aspirin protects senior men from heart attack,
senior women from stroke
March 17, 2009 – Updated recommendations from the
U.S. Preventive Services Task Force say aspirin should be used by older
men to prevent heart attacks and older women to prevent strokes but once
senior citizens reach age 80 it may become too risky to continue aspirin
therapy due to the increased threat of a gastrointestinal hemorrhage.
Patients and clinicians should consider risk
factors - including age, gender, diabetes, blood pressure, cholesterol
levels, smoking and risk of gastrointestinal bleeding - before deciding
whether to use aspirin to prevent heart attacks or strokes, according to
these new recommendations from the U.S. Preventive Services Task Force.
These recommendations do not apply to people who
have already had a heart attack or stroke.
The recommendations are published in today’s issue
(March 17, 2009) of the Annals of Internal Medicine.
The Task Force reviewed new evidence from the
National Institutes of Health’s Women’s Health Study published since the
last Task Force review of this topic in 2002, including a recent
meta-analysis of the risks and benefits of aspirin and found aspirin may
have different benefits and harms in men and women. The Task Force found
good evidence that aspirin decreases first heart attacks in men and
first strokes in women.
The more risk factors people have, the more likely
they are to benefit from aspirin.
The Task Force recommends that men between the ages
of 45 and 79 should use aspirin to reduce their risk for heart attacks
when the benefits outweigh the harms for potential gastrointestinal
bleeding.
Women between the ages of 55 and 79 should use
aspirin to reduce their risk for ischemic stroke when the benefits
outweigh the harms for potential gastrointestinal bleeding. Ischemic
strokes occur as a result of an obstruction within a blood vessel
supplying blood to the brain and are potentially prevented by aspirin
use.
Use of Plavix (clopidogrel) plus PPI at any point in time was
associated with a 25% increased odds of death or rehospitalization
March 3, 2009 - Following a heart attack, unstable
angina or other acute coronary syndrome, patients who receive a
medication to reduce the risk of gastrointestinal bleeding that may be
associated with the use of the antiplatelet drug Plavix and aspirin
have an increased risk of subsequent hospitalization for acute coronary
syndrome or death, according to a study in the March 4 issue of the
Journal of the American Medical Association (JAMA).
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The risk of gastrointestinal bleeding with and
without aspirin use increases with age and is twice as high in men as in
women.
Other risk factors for gastrointestinal bleeding
include upper gastrointestinal tract pain, gastrointestinal ulcers, and
using non-steroidal anti-inflammatory drugs.
The Task Force recommended against using aspirin to
prevent either strokes or heart disease in men under 45 or women under
age 55 because heart attacks are less likely to occur in men younger
than 45 and ischemic strokes are less likely to occur in women younger
than 55, and because limited evidence exists in these age groups.
People age 80 and older could benefit more than
younger people from aspirin because of their higher risk of
cardiovascular disease, but the harms are also greater because the risk
of gastrointestinal bleeding increases with age. The Task Force could
not find clear evidence that the benefits of using aspirin outweigh the
risks in people 80 years or older.
“The decision about whether the benefits of taking
aspirin outweigh the harms is an individual one. Patients should work
with their clinicians to look at their risk factors and decide if taking
aspirin to lower their risk for heart attacks or strokes outweighs the
potential risk of gastrointestinal bleeding,” said Task Force Chair Ned
Calonge, M.D., who is also chief medical officer and state
epidemiologist for the Colorado Department of Public Health and
Information.
Summary of
Recommendations
● The USPSTF
recommends the use of aspirin for men age 45 to 79 years when the
potential benefit due to a reduction in myocardial infarctions outweighs
the potential harm due to an increase in gastrointestinal hemorrhage. Go
to the
Clinical Considerations section for discussion of benefits and
harms.
Grade:
A recommendation.
● The USPSTF
recommends the use of aspirin for women age 55 to 79 years when the
potential benefit of a reduction in ischemic strokes outweighs the
potential harm of an increase in gastrointestinal hemorrhage. Go to the
Clinical Considerations section for discussion of benefits and
harms.
Grade:
A recommendation.
● The USPSTF
concludes that the current evidence is insufficient to assess the
balance of benefits and harms of aspirin for cardiovascular disease
prevention in men and women 80 years or older.
Grade:
I statement.
● The USPSTF
recommends against the use of aspirin for stroke prevention in women
younger than 55 years and for myocardial infarction prevention in men
younger than 45 years.
Grade:
D recommendation.
Cardiovascular disease is the leading cause of
death in the United States. It is the underlying or contributing cause
in approximately 58 percent of all deaths. In 2003, 1 in every 3 adults
had some type of cardiovascular disease. In adults over the age of 40,
the risk of developing cardiovascular disease is 2 in 3 for men and more
than 1 in 2 for women.
The Task Force could not find evidence about what
the optimum dose of aspirin is to prevent heart attacks or strokes.
Evidence shows benefits at a range of doses, and the risk of
gastrointestinal bleeding may increase with the dose.
An aspiring dose as low as 75 mg seems as effective
as higher doses, according to the report.
Taking aspirin increases a person’s chances of
gastrointestinal bleeding, the sudden loss of blood or perforation of
the digestive tract that can lead to hospitalization or death. Taking
aspirin also increases the chance of a hemorrhagic stroke, or bleeding
in the brain, which is different than the ischemic stroke that aspirin
can prevent.
In 2002, the Task Force strongly recommended that
clinicians discuss aspirin use with adults at increased risk for
coronary heart disease and that discussions with patients should address
both the potential benefits and potential harms of aspirin therapy.
The new recommendation provides more specific
guidance about benefits and harms to specific age groups and
gender-specific benefits and provides clinicians with information on how
to estimate an individual’s risks for heart disease or stroke.
The U.S. Preventive Services Task Force is an
independent panel of experts in prevention and primary care. The Task
Force conducts rigorous, impartial assessments of the scientific
evidence for the effectiveness of a broad range of clinical preventive
services, including screening, counseling and preventive medications.
Its recommendations are considered the gold standard for clinical
preventive services.
The recommendations and materials for clinicians is
available on the AHRQ Web site at
http://www.ahrq.gov/clinic/uspstf/uspsasmi.htm. Previous Task Force
recommendations, summaries of the evidence and related materials are
also available on the AHRQ Web site.
Clinical information is also available from AHRQ’s
National Guideline Clearinghouse at
http://www.guideline.gov.
March 17, 2009 – Updated recommendations from the
U.S. Preventive Services Task Force say aspirin should be used by older
men to prevent heart attacks and older women to prevent strokes but once
senior citizens reach age 80 it may become too risky to continue aspirin
therapy due to the increased threat of a gastrointestinal hemorrhage.
‘Aspirin Failure’ leaving 20% of all ages unprotected
from second stroke, heart attack