From the Guidelines
Baby aspirin (low-dose aspirin, typically 81 mg daily) for primary prevention is generally recommended for adults aged 40-70 who have an elevated risk of cardiovascular disease but have not yet experienced a heart attack or stroke, specifically those with a 10-year atherosclerotic cardiovascular disease (ASCVD) risk score of 10% or higher and who don't have an increased risk of bleeding, as supported by the USPSTF recommendation statement 1. The recommendation for baby aspirin use in primary prevention has become more conservative in recent years, with a focus on individualized assessment of cardiovascular risk and bleeding risk.
- Risk factors that might warrant aspirin use include diabetes, hypertension, high cholesterol, smoking, and family history of premature heart disease.
- The American Diabetes Association suggests low-dose aspirin therapy for primary prevention in patients with type 1 or 2 diabetes who have an increased CVD risk (>10% 10-year CVD risk) and are not at increased risk for bleeding 1.
- The American Heart Association recommends the use of low-dose aspirin for cardiovascular prophylaxis in adults whose risk is sufficiently high for the benefits to outweigh the risks associated with treatment, suggesting a 10-year CVD risk of 6% to 10% is sufficient 1. The mechanism behind aspirin's preventive effect is its ability to inhibit platelet aggregation by blocking the production of thromboxane, thereby reducing the formation of blood clots that could lead to heart attacks or strokes.
- For those who do take aspirin, it should be taken consistently at the same time each day, and patients should be aware of potential side effects including gastrointestinal bleeding and allergic reactions. Before starting baby aspirin, patients should consult with their healthcare provider for individualized assessment, considering the balance of benefits and harms, as emphasized by the USPSTF recommendation statement 1.
From the Research
Eligibility Criteria for Baby Aspirin
The decision to prescribe baby aspirin for primary prevention of cardiovascular disease should be based on individual assessment of benefits and risks. The following factors should be considered:
- Cardiovascular risk: Patients at high risk of major adverse cardiovascular events (MACE) may benefit from aspirin therapy 2, 3, 4.
- Age: Patients less than 70 years of age may be more likely to benefit from aspirin therapy 2, 4.
- Bleeding risk: Patients with a high risk of bleeding should not be prescribed aspirin 2, 5, 4.
- Diabetes status: Patients with diabetes may benefit from aspirin therapy, especially if they have a high cardiovascular risk 6, 4.
- Statin therapy: Aspirin therapy may be more effective in patients who are already taking statins 2.
Patient Selection
Patients who may be eligible for baby aspirin for primary prevention of cardiovascular disease include:
- Those with a high 10-year risk of MACE, as determined by a risk assessment tool such as the Framingham Risk Score 3.
- Those with diabetes and one or more other cardiovascular risk factors 3.
- Those who are less than 70 years of age and have a high cardiovascular risk, as long as they do not have a prohibitive risk of bleeding 2, 4.
Considerations
When considering aspirin therapy for primary prevention, clinicians should:
- Assess the patient's cardiovascular risk and bleeding risk 2, 5, 4.
- Discuss the potential benefits and risks of aspirin therapy with the patient 2, 5, 4.
- Consider alternative therapies, such as statins, if the patient is not a good candidate for aspirin therapy 2.
- Monitor the patient for signs of bleeding or other adverse effects if aspirin therapy is initiated 5, 4.