Should a 58-year-old individual with average risk for bleeding be continued on low-dose Aspirin (acetylsalicylic acid) for primary prevention of Cardiovascular Disease (CVD) beyond 60 years of age if they have a life expectancy of 10 years or more?

From the Guidelines

For a 58-year-old who started low-dose aspirin for primary prevention of cardiovascular disease (CVD), they should continue taking it beyond age 60 and complete the full 10-year course as long as they remain at average bleeding risk. The decision to continue aspirin therapy is based on the individual's overall CVD risk profile and anticipated treatment duration, usually planned for 10 years 1. According to the U.S. Preventive Services Task Force recommendation statement, adults aged 60 to 69 years who have a 10% or greater 10-year CVD risk should consider continuing low-dose aspirin daily for at least 10 years if they 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 1.

Key considerations for continuing aspirin therapy include:

• The patient's 10-year CVD risk profile
• Their life expectancy
• Their willingness to continue low-dose aspirin daily
• Regular reassessment of bleeding risk, which naturally increases with age 1
• Monitoring for signs of increased bleeding risk, such as easy bruising, prolonged bleeding, black stools, or stomach pain

The American College of Chest Physicians also suggests low-dose aspirin (75-100 mg/d) for primary prevention of cardiovascular disease in patients aged 50 years or older, with a Grade 2B recommendation 1. However, the most recent and highest quality study, the U.S. Preventive Services Task Force recommendation statement from 2016, takes precedence in guiding clinical decision-making 1.

In terms of dosage, the recommended regimen is typically 81 mg (low-dose) aspirin daily. It is essential to note that the benefit of aspirin in primary prevention comes from its antiplatelet effects that develop over time to reduce the risk of heart attacks and ischemic strokes. Therefore, stopping at age 60 simply because of reaching that age milestone is not recommended if the original plan was for 10 years of therapy and the patient's risk factors haven't changed. Regular follow-up with a healthcare provider is necessary to reevaluate the aspirin therapy if signs of increased bleeding risk develop.

From the FDA Drug Label

The chance is higher if you are age 60 or older The FDA drug label does not answer the question.

From the Research

Aspirin Use for Primary Prevention of CVD

• The use of low-dose aspirin for primary prevention of cardiovascular disease (CVD) is a topic of ongoing debate, with recent studies and guidelines providing evidence-based recommendations 2, 3.
• According to the US Preventive Services Task Force (USPSTF), initiating low-dose aspirin use for primary prevention of CVD in adults 60 years or older has no net benefit, and therefore, it is recommended against 3.
• However, for adults aged 40 to 59 years with a 10% or greater 10-year CVD risk, the USPSTF concludes that aspirin use has a small net benefit, and the decision to initiate low-dose aspirin use should be individualized 3.
• A 58-year-old individual who is started on low-dose aspirin for primary prevention of CVD and remains at average risk for bleeding may consider continuing aspirin use until they reach 60 years old, at which point the net benefit of aspirin use is no longer recommended 3.

Considerations for Aspirin Use

• The decision to continue or stop aspirin use should be based on individualized assessment of CVD risk and bleeding risk, taking into account the patient's clinical characteristics, medical history, and other risk factors 4, 5.
• Recent studies suggest that a personalized treatment approach, balancing CVD risk against bleeding risk, may be beneficial for patients with underlying conditions such as advanced subclinical atherosclerosis 4.
• The use of biomarkers, such as platelet activity, may also help identify individuals who would benefit most from primary CVD prevention with aspirin 6.

Age and Aspirin Use

• The USPSTF recommends against initiating low-dose aspirin use for primary prevention of CVD in adults 60 years or older, citing no net benefit 3.
• However, for adults aged 40 to 59 years with a 10% or greater 10-year CVD risk, aspirin use may be considered, and the decision to continue or stop aspirin use at 60 years old should be individualized 3.