More Evidence to Help Guide Decision Making About Aspirin for Primary Prevention
Authors: Michael Pignone, Darren A. DeWalt
Journal: Annals of Internal Medicine (2018)

Ideas and Opinions4 December 2018More Evidence to Help Guide Decision Making About Aspirin for Primary PreventionMichael Pignone, MD, MPH and Darren A. DeWalt, MD, MPHMichael Pignone, MD, MPHDell Medical School, University of Texas, Austin, Texas (M.P.)Search for more papers by this author and Darren A. DeWalt, MD, MPHUniversity of North Carolina School of Medicine, Chapel Hill, North Carolina (D.A.D.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M18-2637 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Defining the role of aspirin in patients with no history of cardiovascular events (primary prevention) is challenging. Aspirin can have important benefits, including preventing cardiovascular events (1) and possibly reducing the incidence and mortality of some types of cancer (2). However, it can also have important harms, including increasing risk for gastrointestinal bleeding and possibly intracerebral hemorrhage (3). In 2016, the U.S. Preventive Services Task Force examined the body of evidence through a series of systematic reviews and issued a moderate-strength (“B”) recommendation for use of aspirin in “adults aged 50 to 59 years who have a 10% or greater ...References1. Guirguis-Blake JM, Evans CV, Senger CA, O'Connor EA, Whitlock EP. Aspirin for the primary prevention of cardiovascular events: a systematic evidence review for the U.S. Preventive Services Task Force. Ann Intern Med. 2016;164:804-13. [PMID: 27064410]. doi:10.7326/M15-2113 LinkGoogle Scholar2. Chubak J, Whitlock EP, Williams SB, Kamineni A, Burda BU, Buist DS, et al. Aspirin for the prevention of cancer incidence and mortality: systematic evidence reviews for the U.S. Preventive Services Task Force. Ann Intern Med. 2016;164:814-25. [PMID: 27064482]. doi:10.7326/M15-2117 LinkGoogle Scholar3. Whitlock EP, Burda BU, Williams SB, Guirguis-Blake JM, Evans CV. Bleeding risks with aspirin use for primary prevention in adults: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 2016;164:826-35. [PMID: 27064261]. doi:10.7326/M15-2112 LinkGoogle Scholar4. Bibbins-Domingo K; U.S. Preventive Services Task Force. Aspirin use for the primary prevention of cardiovascular disease and colorectal cancer: US Preventive Services Task Force recommendation statement. Ann Intern Med. 2016;164:836-45. [PMID: 27064677]. doi:10.7326/M16-0577 LinkGoogle Scholar5. Pignone M, Earnshaw S, McDade C, Pletcher MJ. Effect of including cancer mortality on the cost-effectiveness of aspirin for primary prevention in men. J Gen Intern Med. 2013;28:1483-91. [PMID: 23681842] doi:10.1007/s11606-013-2465-6 CrossrefMedlineGoogle Scholar6. Dehmer SP, Maciosek MV, Flottemesch TJ, LaFrance AB, Whitlock EP. Aspirin for the primary prevention of cardiovascular disease and colorectal cancer: a decision analysis for the U.S. Preventive Services Task Force. Ann Intern Med. 2016;164:777-86. [PMID: 27064573]. doi:10.7326/M15-2129 LinkGoogle Scholar7. McNeil JJ, Wolfe R, Woods RL, Tonkin AM, Donnan GA, Nelson MR, et al; ASPREE Investigator Group. Effect of aspirin on cardiovascular events and bleeding in the healthy elderly. N Engl J Med. 2018. [PMID: 30221597] doi:10.1056/NEJMoa1805819 CrossrefMedlineGoogle Scholar8. ASCEND Study Collaborative Group. Effects of aspirin for primary prevention in persons with diabetes mellitus. N Engl J Med. 2018. [PMID: 30146931] doi:10.1056/NEJMoa1804988 CrossrefMedlineGoogle Scholar9. McNeil JJ, Nelson MR, Woods RL, Lockery JE, Wolfe R, Reid CM, et al; ASPREE Investigator Group. Effect of aspirin on all-cause mortality in the healthy elderly. N Engl J Med. 2018. [PMID: 30221595] doi:10.1056/NEJMoa1803955 CrossrefMedlineGoogle Scholar10. Pignone M, Williams CD. Aspirin for primary prevention of cardiovascular disease in diabetes mellitus. Nat Rev Endocrinol. 2010;6:619-28. [PMID: 20856266] doi:10.1038/nrendo.2010.169 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Dell Medical School, University of Texas, Austin, Texas (M.P.)University of North Carolina School of Medicine, Chapel Hill, North Carolina (D.A.D.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-2637.Corresponding Author: Michael Pignone, MD, MPH, Department of Internal Medicine, Dell Medical School, DMS Health Discovery Building, Room 7.70, 1701 Trinity Street, Stop Z0900, Austin, TX 78712; e-mail, [email protected]utexas.edu.Current Author Addresses: Dr. Pignone: Department of Internal Medicine, Dell Medical School, DMS Health Discovery Building, Room 7.70, 1701 Trinity Street, Stop Z0900, Austin, TX 78712.Dr. DeWalt: UNC Chapel Hill, 5045 Old Clinic Building, CB 7110, Chapel Hill, NC 27516.Author Contributions: Conception and design: M. Pignone, D.A. DeWalt.Analysis and interpretation of the data: M. Pignone, D.A. DeWalt.Drafting of the article: M. Pignone, D.A. DeWalt.Critical revision of the article for important intellectual content: M. Pignone, D.A. DeWalt.Final approval of the article: M. Pignone, D.A. DeWalt.Administrative, technical, or logistic support: M. Pignone.This article was published at Annals.org on 27 November 2018. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoMore Evidence to Help Guide Decision Making About Aspirin for Primary Prevention Arthur J. Siegel More Evidence to Help Guide Decision Making About Aspirin for Primary Prevention Michael Pignone and Darren A. DeWalt Metrics Cited byEfficacy of Aspirin in the Primary Prevention of Cardiovascular Diseases and Cancer in the Elderly: A Population-Based Cohort Study in KoreaMore Evidence to Help Guide Decision Making About Aspirin for Primary PreventionArthur J. Siegel, MDLow-dose aspirin and risk of upper/lower gastrointestinal bleeding by bleed severity: a cohort study with nested case-control analysis using primary care electronic health records from the United Kingdom 4 December 2018Volume 169, Issue 11Page: 804-805KeywordsAspirinCardiovascular disease riskDecision makingDisclosureElderlyHazard ratioHemorrhageMedical risk factorsMortalityStatins ePublished: 27 November 2018 Issue Published: 4 December 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...