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Level I – Aspirin for the Prevention of Cardiovascular Disease

Level I Services: Preventive services for which clinicians and health systems must assess the need. These services must be recommended to each patient, as they have the highest value and are worthy of attention at every opportunity.

The USPSTF recommendations are fully endorsed by the ICSI Preventive Services work group. Grade of Recommendation and Level of Certainty as Evaluated by USPSTF
  1. “Aspirin use for men ages 45 to 79 years when the potential benefit of a reduction in myocardial infarction outweighs the potential harm of an increase in gastrointestinal hemorrhage.”
  2. “Aspirin use for women ages 55 to 79 years when the potential benefit of a reduction in ischemic stroke outweighs the potential harm of an increase in gastrointestinal hemorrhage.”
  3. “The current evidence is insufficient to assess the balance of benefits and harms of the use of aspirin for cardiovascular disease prevention in men and women age 80 years or older.”
  4. “Against the use of aspirin for stroke prevention in women younger than age 55 years and for myocardial infarction prevention in men younger than age 45 years.”
(USPSTF Last Revised 2009 – Update in Progress)
Grade of Recommendation:
  1. A
  2. A
  3. I Statement
  4. D

Level of Certainty:

  1. High
  2. High
  3. Insufficient
  4. Moderate
“Benefits:
The USPSTF found good evidence that aspirin decreases the incidence of myocardial infarction in men and ischemic strokes in women.
Harms:
The USPSTF found good evidence that aspirin increases the incidence of gastrointestinal bleeding and fair evidence that aspirin increases the incidence of hemorrhagic strokes.
Benefits-Harms Assessment:
The USPSTF concludes that, for men age 45 to 79 years whose benefit due to a reduction in myocardial infarctions exceeds the harm because of an increase in gastrointestinal bleeding, there is high certainty that the net benefit is substantial.
The USPSTF concludes that, for women age 55 to 79 years whose benefit due to a reduction in ischemic stroke exceeds the harm because of gastrointestinal bleeding, there is high certainty that the net benefit is substantial.
The USPSTF concludes that, for men and women 80 years or older, the evidence is insufficient to assess the balance of benefits and harms.
The USPSTF concludes that, for men 44 years or younger and women 54 years or younger, the potential benefits of reducing myocardial infarction in men or ischemic stroke in women are small, and there is moderate certainty that the benefits do not outweigh harms.”
Relevant Resources:
http://www.uspreventiveservicestaskforce.org/uspstf/uspsasmi.htm