Ann Intern Med. 2016 Jun 21;164(12):836-45. doi: 10.7326/M16-0577. Epub 2016 Apr 12.
Update of the 2009 USPSTF recommendation on aspirin use to prevent cardiovascular disease (CVD) events and the 2007 recommendation on aspirin and nonsteroidal anti-inflammatory drug use to prevent colorectal cancer (CRC).
The USPSTF reviewed 5 additional studies of aspirin for the primary prevention of CVD and several additional analyses of CRC follow-up data. The USPSTF also relied on commissioned systematic reviews of all-cause mortality and total cancer incidence and mortality and a comprehensive review of harms. The USPSTF then used a microsimulation model to systematically estimate the balance of benefits and harms.
This recommendation applies to adults aged 40 years or older without known CVD and without increased bleeding risk.
The USPSTF recommends initiating low-dose aspirin use for the primary prevention of CVD and CRC in adults aged 50 to 59 years who have a 10% or greater 10-year CVD risk, 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 for at least 10 years. (B recommendation) The decision to initiate low-dose aspirin use for the primary prevention of CVD and CRC in adults aged 60 to 69 years who have a 10% or greater 10-year CVD risk should be an individual one. Persons who 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 for at least 10 years are more likely to benefit. Persons who place a higher value on the potential benefits than the potential harms may choose to initiate low-dose aspirin. (C recommendation) The current evidence is insufficient to assess the balance of benefits and harms of initiating aspirin use for the primary prevention of CVD and CRC in adults younger than 50 years. (I statement) The current evidence is insufficient to assess the balance of benefits and harms of initiating aspirin use for the primary prevention of CVD and CRC in adults aged 70 years or older. (I statement).
更新 2009 年 USPSTF 关于使用阿司匹林预防心血管疾病（CVD）事件的建议和 2007 年关于使用阿司匹林和非甾体抗炎药预防结直肠癌（CRC）的建议。
USPSTF 审查了 5 项关于阿司匹林用于 CVD 一级预防的额外研究以及 CRC 随访数据的其他几项分析。USPSTF 还依赖于对全因死亡率和总癌症发病率和死亡率的委托系统评价以及对危害的全面审查。然后，USPSTF 使用微模拟模型系统地估计收益和危害的平衡。
本建议适用于年龄在 40 岁或以上、无已知 CVD 且无出血风险增加的成年人。
USPSTF 建议在年龄在 50 至 59 岁、10 年 CVD 风险为 10%或更高、无出血风险增加、预期寿命至少 10 年且愿意每天服用低剂量阿司匹林至少 10 年的成年人中启动低剂量阿司匹林用于 CVD 和 CRC 的一级预防。（B 级建议）在年龄在 60 至 69 岁、10 年 CVD 风险为 10%或更高的成年人中决定启动低剂量阿司匹林用于 CVD 和 CRC 的一级预防应该是个人决定。无出血风险增加、预期寿命至少 10 年且愿意每天服用低剂量阿司匹林至少 10 年的人更有可能受益。更看重潜在益处而不是潜在危害的人可能会选择启动低剂量阿司匹林。（C 级建议）目前的证据不足以评估在 50 岁以下成年人中启动阿司匹林用于 CVD 和 CRC 一级预防的获益与危害的平衡。（I 级声明）目前的证据不足以评估在 70 岁或以上成年人中启动阿司匹林用于 CVD 和 CRC 一级预防的获益与危害的平衡。（I 级声明）。
