ASPREE trial continues to impact international aspirin guidelines

Apr 28, 2022

International medical expert group latest to cite ASPREE findings in guidelines

 

Major findings from the ASPREE trial have been adopted into influential US Preventive Services Taskforce (USPSTF) new medical aspirin guidelines.

The USPSTF recently announced a new recommendation against older adults, aged over 60, starting low-aspirin to prevent cardiovascular disease (CVD; i.e. diseases of the heart and blood vessels).

A grey haired man in a dark suit and blue shirt and tie, sits in front of a window with a computer screen in the background.

Above: Principal Investigator to the ASPREE Trial in Australia, Prof John McNeil

ASPREE Principal Investigator in Australia, Prof John McNeil, said USPSTF recommendations were based on a review of global scientific evidence into the benefits and risks of aspirin use.
“The new USPSTF aspirin guidelines for healthy older adults are now closely aligned to the findings of ASPREE, “ said Prof McNeil.

ASPREE, a world-first aspirin trial in 19,114 healthy older adults in Australia and the US, released its findings to international acclaim in 2018.

Shortly after, the American College of Cardiology and American Heart Association incorporated ASPREE findings into revised primary prevention aspirin guidelines, recommending against aspirin for primary prevention* in adults aged 70 and over.

Guidelines are used by doctors and patients to manage health care.

A statement on the USPSTF website explained the taskforce’s new recommendation: “The magnitude of the harms (of aspirin) is small overall but increases in older age groups, particularly in adults older than 60 years…. The USPSTF concludes with moderate certainty that initiating aspirin use for the primary prevention of CVD events in adults 60 years or older has no net benefit.”

Cardiovascular disease is a leading cause of death in Australia and the US.

The USPSTF did not recommend aspirin to prevent colorectal cancer, citing the need for more evidence.

Prof McNeil said the current lack of evidence for cancer highlights the importance of ASPREE-XT, ASPREE’s follow up study, examining the effect of aspirin on colorectal cancer in older adults over the longer term.

Prof McNeil added the new USPSTF aspirin recommendations only apply to people who do not have a medical reason to take aspirin.
“The use of low-dose aspirin for secondary prevention, such as after a heart attack, should continue,” said Prof McNeil. “Speak to your GP for individual advice before starting or stopping daily low-dose aspirin.”

 

*Primary prevention is a therapy or treatment to prevent a disease or health event from occurring.

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Further reading:

Lay summary:

Jin J. Use of Aspirin to Prevent Cardiovascular Disease. JAMA. 2022;327(16):1624. doi:10.1001/jama.2022.5564

Papers:

US Preventive Services Task Force. Aspirin Use to Prevent Cardiovascular Disease: US Preventive Services Task Force Recommendation Statement. JAMA. 2022;327(16):1577–1584. doi:10.1001/jama.2022.4983

Guirguis-Blake JM, Evans CV, Perdue LA, Bean SI, Senger CA. Aspirin Use to Prevent Cardiovascular Disease and Colorectal Cancer: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2022;327(16):1585–1597. doi:10.1001/jama.2022.3337

Dehmer SP, O’Keefe LR, Evans CV, Guirguis-Blake JM, Perdue LA, Maciosek MV. Aspirin Use to Prevent Cardiovascular Disease and Colorectal CancerUpdated Modeling Study for the US Preventive Services Task ForceJAMA. 2022;327(16):1598–1607. doi:10.1001/jama.2022.3385

Editorial:

Mora S, Shufelt CL, Manson JE. Whom to Treat for Primary Prevention of Atherosclerotic Cardiovascular Disease: The Aspirin Dilemma. JAMA Intern Med. Published online April 26, 2022. doi:10.1001/jamainternmed.2022.1365

Brett AS. Should Patients Take Aspirin for Primary Cardiovascular Prevention? Updated Recommendations From the US Preventive Services Task Force. JAMA. 2022;327(16):1552–1554. doi:10.1001/jama.2022.2460

Lloyd-Jones DM. USPSTF Report on Aspirin for Primary Prevention. JAMA Cardiol. Published online April 26, 2022. doi:10.1001/jamacardio.2022.0935

Berger JS. Aspirin for Primary Prevention—Time to Rethink Our Approach. JAMA Netw Open. 2022;5(4):e2210144. doi:10.1001/jamanetworkopen.2022.10144

Author Interview:  USPSTF Recommendation: Aspirin Use for Cardiovascular Disease

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