Which Patients Actually Need Preventative Low Dose Aspirin?

The answer, simplified.

Keeping up with preventative care guidelines can be pretty confusing. It seems like every professional society related to each specialty publishes their own recommendations. From kidney and liver disease prevention to cardiac and osteoporosis screenings, where do you even begin? One particular preventative measure often recommended by nurse practitioners, taking low dose aspirin to prevent cardiovascular disease, is particularly nebulous. 

I've been practicing as a nurse practitioner for nearly ten years now. In that time, it seems like the recommendations and research about low dose aspirin have constantly changed. Not to mention, my patients tend to be pretty complex and have multiple comorbid diseases making it difficult to know what to recommend as far as prevention and when. Some of the patients I see put themselves on daily low dose aspirin as part of their own preventative efforts. But, which patients actually need to take aspirin as a cardiovascular preventative measure?

Experts recognize the challenges that nurse practitioners and other primary care providers face when it comes to such recommendations. As a result, the U.S Preventative Services Task Force (USPSTF) has amended its recommendations in recent years making them much simpler to follow. According to the USPSTF, here's who needs aspirin

  1. Adults aged 50-59 years with a >10% 10-year cardiovascular disease risk. The USPSTF recommends initiating low-dose aspirin therapy for the primary prevention of cardiovascular disease (CVD) in adults aged 50-59 years who have a 10% or greater 10-year CVD risk (calculated here), who are not at increased risk for bleeding, who have a life expectancy of at least 10 years, and are willing to take low-dose aspirin daily for at least 10 years. This is a grade B recommendation. 
  2. Adults aged 60 to 69 years with a > 10% 10-year cardiovascular disease risk. The decision to take daily low dose aspirin among this population should be an individual one. Individuals who are not at increased risk for bleeding, who have a life expectancy of at least 10 years, and are willing to take low-dose aspirin daily for at least 10 years are most likely to benefit. This is a grade C recommendation. 

That's it! There are currently only two groups of patients to consider, at least as it concerns low dose aspirin recommendations for cardiovascular disease prevention. And, aspirin is optional for the second group (individuals ages 60-69 years). According to the USPSTF, for individuals outside of these age ranges (individuals younger than 50 years and older than 70 years), current evidence is insufficient. 

If these latest aspirin guidelines seem too good to be true, or you're one for nitty gritty details, you can read more about the background and research behind these recommendations on the USPSTF website.

What other preventative guidelines do you struggle to recall or implement?

 

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