Neurologist

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New Recommendations on Aspirin for the Prevention of Cardiovascular Disease

ROCKVILLE, Md — March 17, 2009 — Physicians should consider risk factors including age, gender, diabetes, blood pressure, cholesterol levels, smoking, and risk of gastrointestinal bleeding (GI) before deciding whether to use aspirin to prevent myocardial infarctions (MI) or strokes.

The new recommendations from the US Preventive Services Task Force are published in the March 17 issue of the Annals of Internal Medicine.

The Task Force reviewed new evidence from the National Institutes of Health’s Women’s Health Study published since the last Task Force review of the topic in 2002, including a recent meta-analysis of the risks and benefits of aspirin and found aspirin may have different benefits and harms in men and women.

The Task Force found good evidence that aspirin decreases first MIs in men and first strokes in women. The more risk factors people have, the more likely they are to benefit from aspirin.

The Task Force recommended that men aged 45 to 79 years should use aspirin to reduce their risk for MI when the benefits outweigh the harms for potential GI bleeding.

Women aged 55 to 79 years should use aspirin to reduce their risk for ischaemic stroke when the benefits outweigh the harms for potential GI bleeding.

The Task Force recommended against using aspirin to prevent either strokes or heart disease in men aged under 45 years or women aged under age 55 years because MIs aand strokes are less likely to occur in men and women in this age group, and because limited evidence exists in these age groups.

People aged 80 years and older could benefit more than younger people from aspirin because of their higher risk of cardiovascular disease, but the harms are also greater because the risk of GI bleeding increases with age. The Task Force could not find clear evidence that the benefits of using aspirin outweigh the risks in this age group.

“The decision about whether the benefits of taking aspirin outweigh the harms is an individual one. Patients should work with their clinicians to look at their risk factors and decide if taking aspirin to lower their risk for heart attacks or strokes outweighs the potential risk of gastrointestinal bleeding,” said Task Force Chair Ned Calonge, M.D., who is also chief medical officer and state epidemiologist for the Colorado Department of Public Health and Information.

The Task Force could not find evidence about what the optimum dose of aspirin is to prevent MIs or strokes.

The new recommendation provides more specific guidance about benefits and harms to specific age groups and gender-specific benefits and provides clinicians with information on how to estimate an individual’s risks for heart disease or stroke.

The recommendations and materials for clinicians are available here: http://www.ahrq.gov/clinic/uspstf/uspsasmi.htm.

SOURCE: Agency for Healthcare Research and Quality

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April 7, 2009 - Posted by | 1

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