Aspirin gets the nod for primary cardiac prevention: Postmenopausal women, diabetics targeted. (U.S. Preventive Services Task Force).

Aspirin has been officially declared a key factor in preventing first-time myocardial infarctions and other coronary events.

In a report that goes beyond previous guidelines, the U.S. Preventive Services Task Force "strongly" recommended last month that "clinicians discuss aspirin chemoprevention with adults who are at increased risk of coronary heart disease."

The targeted population includes postmenopausal women, men older than age 40, and younger people with risk factors such as diabetes, family history, hypercholesterolemia, hypertension, and smoking.

An effective dosage of aspirin is about 75 mg/day, although the optimal dosage for chemoprevention is not known, the federally funded USPSTF noted.

For several years, aspirin has been a mainstay of treatment for patients with a myocardial infarction, angina, or other signs of coronary disease. Some physicians also have recommended aspirin to selected patients who have risk factors without overt signs of heart disease. The American Heart Association and other groups that develop clinical guidelines have shied away from recommending routine aspirin use for primary prevention, generally because of the potential downside: an increased risk of cerebral hemorrhage and gastrointestinal bleeding.

"Some physicians have been using aspirin more liberally than the established guidelines for primary prevention in higher-risk people. It's nice that an expert panel has now looked at the data and said that they agree," commented Dr. Roger S. Blumenthal, director of preventive cardiology at Johns Hopkins Hospital, Baltimore.

New evidence prompted the panel's recommendation, explained Dr. Alfred Berg, USPSTF task force chairman. "Until recently, the data have been inconclusive. For the first time, we found enough information [in the literature] to allow physicians and patients to make an informed decision," said Dr. Berg, chair of the department of family medicine at the University of Washington, ...