Aspirin for the Prevention of Cardiovascular Disease: U.S. Preventive Services Task Force Recommendation StatementU.S. Preventive Services Task Force*Description: Update of the 2002 U.S. Preventive Services Task Force (USPSTF) recommendation about the use of aspirin for the prevention of coronary heart disease.Methods: Review of the literature since 2002, focusing on new evi- dence on the benefits and harms of aspirin for the primary prevention of cardiovascular disease, including myocardial infarction and stroke. The new evidence was reviewed and synthesized according to sex.Recommendations: Encourage men age 45 to 79 years to use aspirin when the potential benefit of a reduction in myocardial infarctions outweighs the potential harm of an increase in gastro- intestinal hemorrhage. (A recommendation) Encourage women age 55 to 79 years to use aspirin when the potential benefit of a reduction in ischemic strokes outweighs thepotential harm of an increase in gastrointestinal hemorrhage. (A recommendation) Evidence is insufficient to assess the balance of benefits and harms of aspirin for cardiovascular disease prevention in men and women 80 years or older. (I statement) Do not encourage aspirin use for cardiovascular disease preven- tion in women younger than 55 years and in men younger than 45 years. (D recommendation)Ann Intern Med. 2009;150:396-404.www.annals.org For author affiliation, see end of text. * For a list of the members of the USPSTF, see the Appendix (available at www.annals.org).The U.S. Preventive Services Task Force (USPSTF) makes recommendations about preventive care services for patients without recognized signs or symptoms of the target condition. It bases its recommendations on a systematic review of theevidence of the benefits and harms and an assessment of the netbenefit of the service. The USPSTF recognizes that clinical or policy decisions in- volve more considerations than this body of evidence alone. Cli- nicians and policymakers should understand the evidence but in-dividualize decision making to the specific patient or situation.SUMMARY OFRECOMMENDATION ANDEVIDENCE The USPSTF recommends the use of aspirin for menage 45 to 79 years when the potential benefit due to a reduction in myocardial infarctions outweighs the poten- tial harm due to an increase in gastrointestinal hemorrhage. See the Clinical Considerations section for discussion ofbenefits and harms. This is an A recommendation. The USPSTF recommends the use of aspirin forwomen age 55 to 79 years when the potential benefit of a reduction in ischemic strokes outweighs the potential harm of an increase in gastrointestinal hemorrhage. See the Clin-ical Considerations section for discussion of benefits and harms. This is an A recommendation. The USPSTF concludes that the current evidence isinsufficient to assess the balance of benefits and harms of aspirin for cardiovascular disease prevention in men and women 80 years or older. This is an I statement. See the Clinical Considerations section for suggestions for practice regarding the I statement. The USPSTF recommends against the use of aspirin for stroke prevention in women younger than 55 years and for myocardial infarction prevention in men younger than 45 years. This is a D recommendation. Figure 1 (page 403) shows a summary of the recom- mendations and suggestions for clinical practice. Table 1 describes the USPSTF grades, and Table 2See also:Print Editorial comment. . . . . . . . . . . . . . . . . . . . . . . . . . 414 Related articles. . . . . . . . . . . . . . . . . . . . . . . . 379, 405 Summary for Patients. . . . . . . . . . . . . . . . . . . . . . . I-37Web-Only Appendix CME quiz Conversion of graphics into slides Downloadable recommendation summary Audio summaryAnnals of Internal MedicineClinicalGuidelines396 17 March 2009 Annals of Internal Medicine Volume 150 Number 6www.annals.orgAnnals of Internal Medicinedescribes the USPSTF classification of levels of certainty ofnet benefit.RATIONALE Importance Cardiovascular disease, including heart attack and stroke, is the leading cause of death in the United States.Recognition of Risk Status For many groups, available risk calculators can provide an accurate estimate of the risk for coronary heart disease events and strokes based on information about cardiovas- cular risk factors that include sex. See the Clinical Consid- erations section.Benefits of Preventive Medication The USPSTF found good evidence that aspirin de- creases the incidence of myocardial infarction in men and ischemic strokes in women.Harms of Preventive Medication The USPSTF found good evidence that aspirin in- creases the incidence of gastrointestinal bleeding and fair evidence that aspirin increases the incidence of hemor- rhagic strokes.USPSTF Assessment The USPSTF concludes that, for men age 45 to 79years whose benefit due to a reduction in myocardial in- farctions exceeds the harm because of an increase in gas- trointestinal bleeding, there is h