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On October 12, 2021, the USPSTF issued new guidance on the use of aspirin for the primary prevention of cardiovascular disease (CVD). The new recommendation no longer universally recommends that adults aged 50 - 59 with a 10-year heart attack risk of 10% or more take low-dose aspirin to prevent CVD. The new guideline says that patients should instead "discuss" aspirin with their provider.

The previous recommendation in 2016 was always ill-conceived since every large study that has ever looked at aspirin for the primary prevention of CVD has found that it has no net benefit; even in studies with high-risk populations, aspirin has not been shown to be beneficial (aspirin for primary prevention of CVD). Results from several of these studies were available in 2016, which makes their recommendation even more perplexing.

The 2016 guidance also recommended aspirin for the primary prevention of colon cancer in the same patient population; this seems arbitrary given that the studies for each condition were completely different. Similar to the CVD recommendation, there is no good evidence for this either, as several large studies have found that aspirin has no effect on colon cancer risk in the general population. In the Women's Health Study that enrolled close to 40,000 participants, aspirin was no better than placebo at preventing any type of cancer, including colon cancer. A similar study in male physicians came to the same conclusion. If aspirin even had a minuscule effect, it would have come back significant in studies this size. Hopefully, they will get this recommendation corrected also. (aspirin for colon cancer prevention)

A large amount of data does not support the use of aspirin for any type of primary prevention, and providers can confidently recommend against its use.


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