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Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.
SUMMARIES FOR PATIENTS
Aspirin for the Prevention of Heart Attacks in People without Previous Cardiovascular Events: Recommendations from the United States Preventive Services Task Force
15 January 2002 | Volume 136 Issue 2 | Page I55
Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians-American Society of Internal Medicine.
The summary below is from the full reports titled "Aspirin for the Primary Prevention of Cardiovascular Events: Recommendation and Rationale" and "Aspirin for the Primary Prevention of Cardiovascular Events: A Summary of the Evidence for the U.S. Preventive Services Task Force." They are in the 15 January 2002 issue of Annals of Internal Medicine (volume 136, pages 157-160 and pages 161-172). The first report was written by the U.S. Preventive Services Task Force; the second report was written by M Hayden, M Pignone, C Phillips, and C Mulrow.
What is the United States Preventive Services Task Force?
The United States Preventive Services Task Force (USPSTF) is a group of health experts that reviews published research and makes recommendations about preventive health care.
What is the problem and what is known about it so far?
Heart attack ("myocardial infarction") occurs when blockage develops in the blood vessels that supply the heart muscle. Heart attacks are one of the most common causes of illness and are the leading cause of death in the United States. Certain conditions ("risk factors") increase a person's chance of having a heart attack. They include older age, male sex, high blood pressure, diabetes, smoking, high total or LDL ("bad") cholesterol levels, low HDL ("good") cholesterol levels, and close relatives with heart attacks before age 60. Aspirin decreases the chances of a heart attack in people who have had previous heart attacks or strokes, but its usefulness in people without such a history is unclear. Aspirin can have uncommon but serious complications, such as bleeding in the digestive tract or in the brain.
How did the USPSTF develop these recommendations?
The USPSTF reviewed published research to measure the benefits and harms of aspirin use in adults who have never had a heart attack or stroke.
What did the authors find?
There is good evidence that aspirin decreases heart attacks in people who do not have cardiovascular disease but do have heart attack risk factors. The more risk factors a person has, the more heart attacks aspirin prevents. However, taking aspirin increases a person's chances of complications, such as bleeding in the digestive tract or brain. Complications are most likely in people who have uncontrolled high blood pressure or who take blood thinners or anti-inflammatory drugs in addition to aspirin.
What does the USPSTF suggest that patients do?
Adult patients who have cardiovascular risk factors should discuss the benefits and harms of aspirin to prevent cardiovascular events with their doctors. Patients and doctors can use a tool located at http://www.med-decisions.com to calculate a person's risk of a future heart attack. If a patient's chance of having a heart attack over the next 5 years is at least 3 out of 100 (3%), then the benefits of aspirin are likely to outweigh the harms. However, there is no single correct answer for all patients. The decision to take aspirin or not will depend on the patient's feelings about avoiding heart attacks while risking the possible complications of bleeding in the digestive tract or brain.
What are the cautions related to these recommendations?
Participants in the studies that the USPSTF used to develop the recommendations were mostly men who were 40 to 75 years of age. Estimates of benefits and harms may not be reliable for women or for older men.
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T. I. Shireman, P. A. Howard, T. F. Kresowik, and E. F. Ellerbeck Combined Anticoagulant-Antiplatelet Use and Major Bleeding Events in Elderly Atrial Fibrillation Patients Stroke, October 1, 2004; 35(10): 2362 - 2367. [Abstract] [Full Text] [PDF]
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S. Woloshin and L. M. Schwartz Association of Aspirin Use and Hormone Receptor Status With Breast Cancer Risk JAMA, September 22, 2004; 292(12): 1426 - 1427. [Full Text] [PDF]
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 J. van Ryn, M. Kink-Eiband, I. Kuritsch, U. Feifel, G. Hanft, G. Wallenstein, G. Trummlitz, and M. Pairet Meloxicam Does Not Affect the Antiplatelet Effect of Aspirin in Healthy Male and Female Volunteers J. Clin. Pharmacol., July 1, 2004; 44(7): 777 - 784. [Abstract] [Full Text] [PDF]
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M. J. Pletcher, J. A. Tice, M. Pignone, and W. S. Browner Using the Coronary Artery Calcium Score to Predict Coronary Heart Disease Events: A Systematic Review and Meta-analysis Arch Intern Med, June 28, 2004; 164(12): 1285 - 1292. [Abstract] [Full Text] [PDF]
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E. R. Cox, M. Frisse, A. Behm, and K. A. Fairman Over-the-Counter Pain Reliever and Aspirin Use Within a Sample of Long-term Cyclooxygenase 2 Users Arch Intern Med, June 14, 2004; 164(11): 1243 - 1246. [Full Text] [PDF]
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 C. Hur, N. S. Nishioka, and G. S. Gazelle Cost-Effectiveness of Aspirin Chemoprevention for Barrett's Esophagus J Natl Cancer Inst, February 18, 2004; 96(4): 316 - 325. [Abstract] [Full Text] [PDF]
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R. S. Sandler Aspirin Prevention of Colorectal Cancer: More or Less? Ann Intern Med, February 3, 2004; 140(3): 224 - 225. [Full Text] [PDF]
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 K. N. Lohr Rating the strength of scientific evidence: relevance for quality improvement programs Int. J. Qual. Health Care, February 1, 2004; 16(1): 9 - 18. [Abstract] [Full Text] [PDF]
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R. Landolfi, R. Marchioli, J. Kutti, H. Gisslinger, G. Tognoni, C. Patrono, T. Barbui, and the European Collaboration on Low-Dose Aspirin in Efficacy and Safety of Low-Dose Aspirin in Polycythemia Vera N. Engl. J. Med., January 8, 2004; 350(2): 114 - 124. [Abstract] [Full Text] [PDF]
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J. A. Baron What Now for Aspirin and Cancer Prevention? J Natl Cancer Inst, January 7, 2004; 96(1): 4 - 5. [Full Text] [PDF]
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C. Patrono, F. Bachmann, C. Baigent, C. Bode, R. De Caterina, B. Charbonnier, D. Fitzgerald, J. Hirsh, S. Husted, J. Kvasnicka, et al. Expert Consensus Document on the Use of Antiplatelet Agents: The Task Force on the Use of Antiplatelet Agents in Patients with Atherosclerotic Cardiovascular Disease of the European Society of Cardiology Eur. Heart J., January 2, 2004; 25(2): 166 - 181. [Full Text] [PDF]
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 M. Brezis and R. Cohen Interactive learning in medicine: Socrates in electronic clothes QJM, January 1, 2004; 97(1): 47 - 51. [Abstract] [Full Text] [PDF]
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Standards of Medical Care in Diabetes Diabetes Care, January 1, 2004; 27(90001): s15 - 35. [Full Text] [PDF]
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Aspirin Therapy in Diabetes Diabetes Care, January 1, 2004; 27(90001): s72 - 73. [Full Text] [PDF]
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M. Sacco, F. Pellegrini, M. C. Roncaglioni, F. Avanzini, G. Tognoni, and A. Nicolucci Primary Prevention of Cardiovascular Events With Low-Dose Aspirin and Vitamin E in Type 2 Diabetic Patients: Results of the Primary Prevention Project (PPP) trial Diabetes Care, December 1, 2003; 26(12): 3264 - 3272. [Abstract] [Full Text] [PDF]
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E. Lutgens, R.-J. van Suylen, B. C. Faber, M. J. Gijbels, P. M. Eurlings, A.-P. Bijnens, K. B. Cleutjens, S. Heeneman, and M. J.A.P. Daemen Atherosclerotic Plaque Rupture: Local or Systemic Process? Arterioscler. Thromb. Vasc. Biol., December 1, 2003; 23(12): 2123 - 2130. [Abstract] [Full Text] [PDF]
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T. Marshall Coronary heart disease prevention: insights from modelling incremental cost effectiveness BMJ, November 29, 2003; 327(7426): 1264. [Abstract] [Full Text] [PDF]
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 R. von Kanel and J. E. Dimsdale Hemostatic Alterations in Patients With Obstructive Sleep Apnea and the Implications for Cardiovascular Disease Chest, November 1, 2003; 124(5): 1956 - 1967. [Abstract] [Full Text] [PDF]
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K. A Dornbrook-Lavender, J. A Pieper, and M. T Roth Primary Prevention of Coronary Heart Disease in the Elderly Ann. Pharmacother., November 1, 2003; 37(11): 1654 - 1663. [Abstract] [Full Text] [PDF]
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V. M. Montori, S. C. Bryant, A. M. O'Connor, N. W. Jorgensen, E. E. Walsh, and S. A. Smith Decisional Attributes of Patients With Diabetes: The aspirin choice Diabetes Care, October 1, 2003; 26(10): 2804 - 2809. [Abstract] [Full Text] [PDF]
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T. Kurth, R. J. Glynn, A. M. Walker, K. A. Chan, J. E. Buring, C. H. Hennekens, and J. M. Gaziano Inhibition of Clinical Benefits of Aspirin on First Myocardial Infarction by Nonsteroidal Antiinflammatory Drugs Circulation, September 9, 2003; 108(10): 1191 - 1195. [Abstract] [Full Text] [PDF]
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J. Burke, W. K. Kraft, H. E. Greenberg, M. Gleave, G. M. Pitari, S. VanBuren, J. A. Wagner, and S. A. Waldman Relationship of Arachidonic Acid Concentration to Cyclooxygenase-Dependent Human Platelet Aggregation J. Clin. Pharmacol., September 1, 2003; 43(9): 983 - 989. [Abstract] [Full Text] [PDF]
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M. T. Nurmohamed, W. F. Lems, A. Lanas, D. F. McKeogh, F. K.L. Chan, and D. Y. Graham Celecoxib versus Diclofenac and Omeprazole to Prevent Recurrent Ulcer Bleeding N. Engl. J. Med., June 12, 2003; 348(24): 2464 - 2466. [Full Text] [PDF]
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