The US Preventive Services Task Force (USPSTF) has issued a recommendation statement on aspirin use for the primary prevention of cardiovascular disease and colorectal cancer. The recommendation applies to adults aged ≥40 years without known CVD and without increased bleeding risk. For this update, the USPSTF reviewed 5 additional studies of aspirin for the primary prevention of CVD and several additional analyses of CRC follow-up date and recommends:

• Initiating low-dose aspirin use for the primary prevention of CVD and CRC in adults aged 50 to 59 years who have a 10% or greater 10-year CVD risk, are not at increased risk for bleeding, have a life expectancy of at least 10 years, and are willing to take low-dose aspirin for at least 10 years (B recommendation).

• The decision to initiate low-dose aspirin use for the primary prevention of CVD and CRC in adults aged 60 to 69 years who have a 10% or greater 10-year CVD risk should be an individual one. Persons who are not at increased risk for bleeding, have a life expectancy of at least 10 years, and are willing to take low-dose aspirin daily for at least 10 years are more likely to benefit. Persons who place a higher value on the potential benefits than the potential harms may choose to initiate low-dose aspirin. (C recommendation).

• The current evidence is insufficient to assess the balance of benefits and harms of initiating aspirin use for the primary prevention of CVD and CRC in adults younger than 50 years. (I statement).

• The current evidence is insufficient to assess the balance of benefits and harms of initiating aspirin use for the primary prevention of CVD and CRC in adults aged 70 years or older. (I statement).

Citation: Bibbins-Domingo K, et al. Aspirin use of the primary prevention of cardiovascular disease and colorectal cancer: U.S. preventive services task force recommendation statement. [Published online ahead of print April 12, 2016]. Ann Intern Med. doi:10.7326/M16-0577.

Commentary: Cardiovascular disease, including stroke, is the cause of 30% of deaths in the US. Colorectal cancer leads to 50,000 deaths a year in the US. Any intervention that decreases the rate of development of these 2 diseases can have a significant positive effect on the health of the population in the US. Studies of low-dose aspirin for primary prevention of CV disease in high-risk groups show a 17% decrease in incidence of MI and a 14% decrease in the rate of stroke. Meta-analysis shows a 5% decrease in total mortality, just missing statistical significance. For colorectal cancer studies have shown a 40% reduction in incidence with aspirin use. Major GI bleeding increased by 58% in aspirin users and hemorrhagic bleeding increased by approximately 25%. For patients at elevated cardiac risk, and without elevated bleeding risks, aspirin appears to provide a significant net benefit. —Neil Skolnik, MD