The U.S. Preventive Services Task Force now recommends that aspirin be used in men to prevent MIs (Myocardial Infarction) — and in women to prevent ischemic strokes — when these benefits outweigh the risks for gastrointestinal bleeding.

The task force considers older age and male sex as the major risk factors for gastrointestinal bleeding, followed by upper GI pain, ulcers, and NSAID use.

The recommendations, published in Annals of Internal Medicine, update the USPSTF’s previous statement, released in 2002. The current statement factors in evidence from the Women’s Health Study that “aspirin may have differential benefits and harms in men and women.” The task force also concludes that evidence is “insufficient” to weigh the benefits and harms of aspirin prophylaxis among people over age 79 — and that use among men under 45 or women under 55 should not be encouraged. An editorialist writes: “Aspirin continues to be underused, and the routine incorporation of the USPSTF’s recommendations … [will] prevent many thousands of cardiovascular events every year.”
Here is a summary of the recommendations to physicians:
1. Encourage men age 45 to 79 years to use aspirin when the potential benefit of a reduction in myocardial infarctions (heart attack) outweighs the potential harm of an increase in gastrointestinal hemorrhage. (A recommendation)
2. Encourage women age 55 to 79 years to use aspirin when the potential benefit of a reduction in ischemic strokes outweighs the potential harm of an increase in gastrointestinal hemorrhage. (A recommendation)
3. 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)
4. Do not encourage aspirin use for cardiovascular disease prevention in women younger than 55 years and in men younger than 45 years. (D recommendation).