Guidelines for the Use of Daily Aspirin for the Primary Prevention of Myocardial Infarction in Men and Cerebral Vascular Disease in Women

By Farah Kaiksow

The following information is summarized from the USPSTF March 2009 publication. Please note, the USPSTF is currently in the process of updating this publication.

  • Daily low-dose aspirin decreases the risk of myocardial infarction in men aged 45-79 years, but not in women.

  • Daily low-dose aspirin decreases the risk of ischemic cerebrovascular disease in women aged 55 to 79 years, but not in men.

  • Primary Care Physicians should recommend daily aspirin for men and women in the above age groups if their calculated risk of MI or ischemic CVD, respectively, outweighs their risk of gastrointestinal hemorrhage.

Population

Men
Age 45-79 Years

Women
Age 55-79 Years

Women
Age 55-79 Years

Women
Age 55-79 Years

Men and Women Over 80 Years

Recommendation

Encourage aspirin use when potential CVD benefit (MIs prevented) outweighs potential harm of GI hemorrhage.

Encourage aspirin use when potential CVD benefit (strokes prevented) outweighs potential harm of GI hemorrhage.

Do not encourage aspirin use for MI prevention.

Do not encourage aspirin use for stroke prevention.

No Recommendation

Grade

A

(High certainty that the net benefit is substantial.)

D

(Moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.)

I

(Insufficient Evidence)

For patients who do not take NSAIDs regularly and do not have a history of GI bleed or ulcers, the table below should be used to determine if the benefits of aspirin outweigh the risks of GI side effects.

10-year CHD risk for Men

10-year stroke risk for Women

Age 45-59 years

≥4%

Age 45-59 years

≥3%

Age 60-69 years

≥9%

Age 60-69 years

≥8%

Age 70-79 years

≥12%

Age 70-79 years

≥11%

Primary Care Physicians should use the following calculators to determine their patients’ 10-year risk of CHD or ischemic stroke:

  • Men (CHD)

  • Women (stroke)

Please note, the original stroke risk calculator (Western States Consortium) cited by the USPSTF is no longer available.

For patients who do take NSAIDs regularly or have a history of GI bleed or ulcers, Primary Care Physicians should carefully weigh the risks and benefits of daily aspirin as it more than doubles a patient’s risk of GI bleed or ulcer.

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