USPSTF advises against aspirin for primary CVD prevention for adults 60 years or older

 

So rather than solving the real problem of identifying specifically which persons have this internal bleeding problem, they went down the sledgehammer route.

Don't listen to me, I'm not medically trained, but I do have good questions for your doctor to know the answers to.

USPSTF advises against aspirin for primary CVD prevention for adults 60 years or older

By Scott Buzby

Source/Disclosures

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The U.S. Preventive Services Task Force no longer recommends aspirin for primary CVD prevention in adults aged 60 years or older, according to a draft recommendation issued today.

The draft statement also recommends that use of aspirin for primary CVD prevention in adults aged 40 to 59 years at high risk for CVD should be considered on a case-by-case basis.

Data were derived from Aspirin Use to Prevent Cardiovascular Disease: U.S. Preventive Services Task Force Draft Recommendation Statement. Published and accessed Oct. 12, 2021.

The new recommendations are different from those issued by the task force in 2016, which supported aspirin for primary prevention in adults aged 50 to 59 with a 10-year CVD risk of at least 10% and stated adults aged 60 to 69 with a 10-year CVD risk of at least 10% could be considered for aspirin for primary prevention on a case-by-case basis.

In the interim, trials such as ARRIVE, ASCEND and ASPREE suggested the benefits of aspirin for primary prevention of CVD may not outweigh the risks, and the American College of Cardiology and American Heart Association issued a primary prevention guideline that advised against the use of aspirin for primary prevention except in patients at very high CVD risk.

According to the statement, CVD accounts for about 1 in 3 deaths in the U.S., and each year, an approximately 605,000 Americans experience a first MI and about 610,000 experience a first stroke.

The updated recommendations

The USPSTF issued a grade C recommendation regarding the use of aspirin for primary prevention in adults aged 40 to 59 years with a 10% or greater 10-year CVD risk. A grade C recommendation is dependent on a patient’s unique situation.

According to the statement, the decision to initiate low-dose aspirin for primary prevention of CVD in this population should be made on an individual basis, as evidence of net benefit in this group is small. In addition, patients who are not at increased risk for bleeding and are willing to take low-dose aspirin daily are more likely to benefit, the task force wrote.

The recommendation regarding the use of aspirin for primary prevention in adults aged 60 years or older was Grade D, which indicates that a treatment is not recommended for a specific group.

“Daily aspirin use may help prevent heart attacks and strokes in some people, but it can also cause potentially serious harms, such as internal bleeding,” John Wong, MD, interim chief scientific officer, vice chair for clinical affairs, chief of the division of clinical decision making and primary care clinician in the department of medicine at Tufts Medical Center, and member of the USPSTF, said in a press release. “It’s important that people who are 40 to 59 years old and don’t have a history of heart disease have a conversation with their clinician to decide together if starting to take aspirin is right for them.”

Recommendation rationale

To evaluate the benefits of aspirin for primary prevention of CV morbidity and mortality, the task force pooled the results of 13 randomized clinical trials, which included a total of 161,680 participants.

According to the statement, the findings from of the pooled analysis indicated that aspirin for the primary prevention of CVD is associated with decreased risk for MI and stroke but not CV or all-cause mortality. Moreover, findings were similar when trials using various doses of aspirin were compared with studies of low-dose aspirin.

To evaluate the harms of aspirin for primary prevention of CV morbidity and mortality, the task force pooled the results of 14 randomized clinical trials that reported on bleeding events associated with aspirin use.

Researchers reported that the increased risk for bleeding associated with aspirin use occurred soon after aspirin initiation. According to the statement, the relative bleeding risk associated with aspirin use did not change based on patients age, sex, diabetes status, level of CVD risk or race/ethnicity. Despite this, the absolute bleeding risk, and subsequently the magnitude of bleeding harm, does increase with age, especially in adults aged 60 years or older.

“The latest evidence is clear: starting a daily aspirin regimen in people who are 60 or older to prevent a first heart attack or stroke is not recommended,” Chien-Wen Tseng, MD, MPH, MSEE, the Hawaii Medical Service Association endowed chair in health services and quality research, professor and research director in the department of family medicine and community health at the University of Hawaii John A. Burns School of Medicine, and USPSTF member, said in the release. “However, this Task Force recommendation is not for people already taking aspirin for a previous heart attack or stroke; they should continue to do so unless told otherwise by their clinician.”

The USPSTF stated that more research is needed in the following areas:

• gastrointestinal bleeding risk associated with aspirin use in populations representative of the U.S. primary prevention population;
• accuracy of CVD risk prediction in all racial/ethnic and socioeconomic groups;
• characterizing of patient preferences across the spectrum of CV risk after patients are informed about the benefits and harms of aspirin; and
• the effects of low-dose aspirin on colorectal cancer incidence and mortality over the long-term in primary prevention populations, and in the context of current colorectal cancer screening practices.

Please see the USPSTF statement for full detail on this draft recommendation.

 

Without heart disease, daily aspirin may be too risky

Well then come up with an exact test that will identify those at risk instead of these blanket warnings.

Without heart disease, daily aspirin may be too risky

Reuters Health News | May 14, 2019

For people without heart disease, taking a daily aspirin to prevent heart attacks and strokes may increase the risk of severe intracranial bleeding to the point where the risk outweighs any potential benefit, a research review suggests.

US doctors have long advised adults who haven't had a heart attack or stroke but are at high risk for these events to take a daily aspirin pill. Even though there's clear evidence aspirin works for this purpose, many physicians and patients have been reluctant to follow the recommendations because of the risk of rare but potentially lethal internal bleeding.
For the current study, researchers examined data from 13 clinical trials testing the effects of aspirin against a placebo or no treatment in more than 134,000 adults. The risk of intracranial hemorrhage was rare: taking aspirin was associated with two additional cases of this type of internal bleeding for every 1,000 people, the study found. But the bleeding risk was still 37% higher for people taking aspirin.
"Intracranial hemorrhage is a special concern because it is strongly associated with a high risk of death and poorer health over a lifetime," said study co-author Dr. Meng Lee of Chang Gung University College of Medicine in Taiwan.
"These findings suggest caution regarding using low-dose aspirin in individuals without symptomatic cardiovascular disease," Lee said by email.
For people who have already had a heart attack or stroke, the benefit of low-dose aspirin to prevent another major cardiac event is well established, researchers noted May 13, 2019, online in JAMA Neurology. But the value of aspirin is less clear for healthier people, for whom bleeding risks may outweigh any benefit, the study team writes.

• See Also: Pregnant women with congenital heart defects have more complications, comorbidities

Already, guidelines on aspirin for primary prevention of heart disease in the United States, Europe, and Australia have incorporated a need to balance the potential benefits against the risk of bleeding. For elderly people, who have a greater risk of bleeding than younger adults, the risks may be too great to recommend aspirin.
For adults ages 50 to 59 considering aspirin to prevent heart attacks and strokes, for example, the US Preventive Services Task Force (USPSTF) recommends the pill only for people who have at least a 10% risk of having a heart attack or stroke over the next decade and who don't have a higher-than-average risk of bleeding. (I'm pretty sure my risk of having a stroke was near zero, because there is no way to determine the amount of plaque in your arteries without some sort of test. Questionnaires don't cut it.)
One limitation of the analysis is that the smaller clinical trials examined a variety of aspirin doses up to 100 mg daily. The analysis also only focused on brain bleeds, and not on other types of internal bleeding associated with aspirin.
"We have long known that aspirin can precipitate bleeding, most commonly in the gastrointestinal tract, but most devastatingly in the brain," said Dr. Samuel Wann, a cardiologist at Ascension Healthcare in Milwaukee, WI, who wasn't involved in the study.
Despite the benefits for preventing heart attacks, the consensus on aspirin has changed over time, particularly for people without heart disease. "We have previously recommended aspirin to prevent platelets from sticking to the inside of an individual's arteries, but the benefit, while real, turns out to be small compared to the rare but devastating incidence of brain hemorrhage," Wann said by email. "We no longer recommend routine use of aspirin in individuals who have no demonstrable cardiovascular disease or atherosclerosis."
—Lisa Rapaport

• See Also: Heart arrhythmia can be acquired by people who are stressed, even with no genetic predisposition

To read more, click here.

USPSTF: No Proven Value in Cognition Screening

Sorry, but I vehemently disagree with this. I want to know as soon as possible so I can put my dementia prevention program into overdrive.  I think a lot of this is because there is no decent pharmacological intervention and they stupidly have not been reading all the research on small daily activities that can help. They are almost as stupid as the stroke medical world. Throw up your hands in defeat before you have even started the game.
http://www.medpagetoday.com/PrimaryCare/Geriatrics/44914?
Routine screening of all older individuals for cognitive impairment is not supported by the available evidence, the U.S. Preventive Services Task Force (USPSTF) has concluded.

More at link.

Stroke Rounds: USPSTF Says Carotid Screening Overused

Well the lack of information and vigorous thinking continues. After my dad had his carotid endarterectomy, his doctor should have known what the chances were that any children might have problems. My doctor who finally did an ultrasound on my carotids 3 years post stroke found that my right carotid had totally closed up. His thought was that it probably was 80% clogged at the time of the stroke. With the knowledge that maybe I should have had my carotids scanned, my stroke was totally preventable. In a complete failure of hospital procedures my carotid blockage was never found or looked for. So for 3 years I was at an extremely high risk of dissecting the exact same artery again.  But I managed to miss that bullet which is why I can be a complete pain in the ass right now to all things stroke related. But don't listen to me, I'm not medically trained and thus should just shut up and die. Have fun people, I am. This is probably more against those independent traveling clinics like Lifeline because they are outside of the normal medical channels.

Stroke Rounds: USPSTF Says Carotid Screening Overused

The U.S. Preventive Services Task Force (USPSTF) has reaffirmed its recommendation against screening asymptomatic adults(I was asymptomatic)  in the general population for carotid artery stenosis, draft guidance showed.
After an updated review of the evidence, the USPSTF concluded "with moderate certainty that the harms of screening for asymptomatic carotid artery stenosis outweigh the benefits."
The recommendation against screening is consistent with the task force's previous 2007 guidance on the topic, as well as guidelines from other major organizations, including the American Heart Association/American Stroke Association and the American College of Cardiology.
Several factors contribute to the consensus that routine screening isn't a good idea.
Studies indicate that the prevalence of carotid artery stenosis is low in the general population, at 1% or lower. When stenosis is present, few cases actually trigger a stroke, and there are no reliable ways to identify the problematic cases.(Has any research been done at all? With the correct amount of data this question could be easily solved. Stop throwing up your hands and accepting defeat at the slightest bump. In my organization you would be fired for that defeatist attitude.)

More at link