New Guidelines Discourage Aspirin Use for Primary ASCVD Prevention

New guidelines from the American College of Cardiology/American Heart Association (ACC/AHA) recommend that, due to a lack of net benefit, aspirin should be used infrequently in the routine primary prevention of atherosclerotic cardiovascular disease (ASCVD).

In order to “consolidate existing recommendations and various recent scientific statements, expert consensus documents, and clinical practice guidelines into a single guidance document focused on the primary prevention of ASCVD,” the ACC/AHA Take Force on Clinical Practice Guidelines commissioned a review of available data on 9 topic areas: risk assessment, diet, exercise/physical activity, obesity and weight loss, type 2  diabetes  mellitus,  blood  cholesterol,  hypertension,  smoking  cessation,  and  aspirin  use.

Most notably among the group’s recommendations are those concerning aspirin, stating that it should be used infrequently for routine primary prevention. Further, in patients aged 70 years and older, aspirin use for primary prevention is potentially harmful and “difficult to justify” because of the higher risk of bleeding in these patients.

Among the other recommendations:

• Adults aged 40 to 75 years who are being evaluated for CVD prevention should undergo 10-year ASCVD risk estimation before starting pharmacological therapy.
• In adults with type 2 diabetes mellitus, metformin should be the first-line therapy when medication is indicated, followed by consideration of a sodium-glucose cotransporter 2 inhibitor or a glucagon-like peptide-1 receptor agonist.
• Statins, with lifestyle changes, are recommended for patients with elevated LDL levels, type 2 diabetes, or other cardiovascular risk factors.

“This primary-prevention guideline strives to provide clinicians with the information they need to help their patients reduce their risk of ASCVD and encourage them to make healthier lifestyle changes when needed,” they concluded.

—Michael Potts

Reference:

Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease. 2018. Journal of the American College of Cardiology. https://doi.org/10.1016/j.jacc.2019.03.010