On Tuesday, the United States Preventive Services Task Force (USPSTF) released a new draft recommendation on the use of low-dose aspirin as a preventative measure for cardiovascular diseases such as heart attack and stroke.
Guidance-This is Public comments open until November 8th— There are two main components.
- Adults aged 40 to 59 years who have no history of cardiovascular disease (CVD) but have a 10-year risk of CVD of 10% or more should be considered on a case-by-case basis before starting prophylactic low-dose aspirin use. need to do it.
- Recommendations for starting the use of low-dose aspirin for primary prevention of CVD in people over the age of 60
The Independent Commission’s draft recommendations reflect new clinical evidence published since the previous guidance from 2016. These international studies weighed the net benefits of CVD event prevalence over increased risk of “potentially serious harm such as internal bleeding.” Said in a statement.
The Task Force, Heart Disease Expert Organization, and individual clinical experts all emphasize that both parts of the new guidance are intended only for patients who have no history of CVD and have not yet taken aspirin daily. bottom. They said patients with established CVD, having stents in the arteries, or having artificial heart valves should continue to use the prescribed aspirin.
In particular, experts emphasized that changes in prescribed medications should be guided by the patient’s healthcare provider.
“If you’re 40-59 years old and have no history of heart disease, it’s important to discuss it with your clinician to determine if it’s right for you to start taking aspirin,” Wong said. I have.
The American Heart Association (AHA) said in a statement that the new USPSTF guidance follows its own recommendations for primary prevention of CVD announced in 2019. AHA’s Donald said, “to encourage clinicians to be very selective when prescribing aspirin,” because the overall CVD protective effect of aspirin is “small” and often offset by the risk of bleeding. M. Lloyd Jones, MD, said in a statement.
Demilade A, a cardiologist at the Mayo Clinic in Jacksonville, Florida, who is not affiliated with the USPSTF. Adedinsewo said in an email that the new recommendations could have a far greater impact on primary care practices than cardiovascular professionals. In addition, she noted that statins are “much more effective in preventing cardiovascular disease and are currently preferred for primary prevention in patients who meet the criteria for use.”
Note the latest guidance on the use of preventive aspirin as C. Noel Bairey Merz, MD, Director of Barbra Streisand Women’s Heart Center, Professor of Cardiology at Cedars-Sinai Medical Center, and not affiliated with the USPSTF. Asserts that it reflects a broader scope of the field of cardiology. Recent discussions.
However, she said that treatments other than aspirin and lifestyle changes are not always viable options for some older patients. She said clinicians need to weigh treatment-related health risks along with patient concerns, behaviors, and other restrictions in order to come up with an appropriate CVD prevention strategy, whether aspirin or not.
“Most patients and doctors [heart attack or stroke] Causes a serious morbidity [bleeding] Mostly not, “Meltz said in an email statement. “In addition, not all older people can take statins, carefully control their blood pressure, or quit smoking. Therefore, sharing decisions between doctors and patients can lead to a preventative approach. It can be personalized. “
Patient-doctor conversations will be especially important in the coming days. As news of the USPSTF’s recommendations spread to the general public, Meltz said providers should be ready to answer new questions or unconsulted treatment changes.
“Unfortunately, these updated guidances usually result in established cardiovascular patients stopping aspirin or calling their doctor’s office for guidance,” she said. rice field.
Merz also said that recent research data USPSTF recommendations reflect the outcomes of patients living in wealthy Western countries, more specifically in countries such as Australia and the United Kingdom, where national health care systems differ significantly from the United States. Warned that it is based on.
In the future, she said she would like to see more published studies and recommendations on prophylactic aspirin use across these untreated populations.
“Because a new trial has been conducted … Need to address the usefulness of aspirin in the United States, especially in the low and middle levels, using a safety net socialized healthcare system with high quality of health care and low rate of adverse health effects. there is. [socioeconomic status] People who do not have access to quality medical care other than emergency care, “she said.
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