Aspirin Use to Prevent Cardiovascular Disease: Preventive Medication


Presents aspirin therapy recommendations for adults 40-59 years old with a >=10% 10-Year CVD risk score

Creation Date
Unique Identifier
CDS 008

Artifact Creation and Usage


This artifact was developed by MITRE software engineers and clinical informaticists, in collaboration with clinical subject matter experts and leaders from the U.S. Preventive Services Task Force (USPSTF).

Additional information about the USPSTF's preventive health expertise is available here.

Additional information about MITRE's health expertise is available here.

If you would like further information, would like to give us feedback, or have any questions about this artifact, please contact us at ClinicalDecisionSupport@ahrq.hhs.gov.

IP Attestation The author asserts that this artifact has been developed in compliance with the intellectual property rights attributed to the source material.

Copyright is held by U.S. Preventive Services Task Force and administered by AHRQ.

Repository Information
Approval Date
Publication Date
Last Review Date
Knowledge Level

Semi-structured text that describes the recommendations for implementation in CDS

Purpose and Usage

Provides an evidence-based recommendation for aspirin therapy to mitigate a patient's elevated risk of developing CVD

Intended Population

This artifact applies to adults aged 40 to 59 years with a =>10 year CVD risk


This artifact is intended to be used by providers while delivering care in an outpatient setting


A new and significantly changed recommendation was published by the U.S. Preventive Services Task Force on April 26, 2022. This CDS Connect artifact reflects the new recommendation.

Note that a Grade D recommendation (U.S. Preventive Services Task Force recommends against initiating low-dose aspirin for individuals age 60 years and older) is not included in this artifact.

Implementation details: The CDS implementer can adjust the age parameters.

This artifact is intended for use in outpatient settings only and should not be used in acute care settings.

Additional information and resources: CDS Connect artifacts are not “standalone” and are not intended to be completely plug-and-play (i.e., healthcare systems will need to integrate each artifact with components of their health information technology (IT) system for the artifact to work.) CQL Services, an open source publicly-available tool that facilitates integration of CQL code with a health IT system, can be used by organizations that build out a coded expression of this artifact for pilot implementation in their healthcare organization. CQL Services is available here: https://github.com/AHRQ-CDS/AHRQ-CDS-Connect-CQL-SERVICES. Implementers should conduct extensive testing, including clinical testing in real-life workflows, of all artifacts. It is expected that artifacts will be customized and adapted to local clinical and IT environments.

The U.S. Preventive Services Task Force recommendations are in the Final Research Plan phase of the development process for an updated Recommendation.

Supporting Evidence
Source Description

Derived from Aspirin Use to Prevent Cardiovascular Disease: Preventive Medication (2022). 


US Preventive Services Task Force. Aspirin Use to Prevent Cardiovascular Disease: US Preventive Services Task Force Recommendation Statement. JAMA. 2022;327(16):1577–1584. doi:10.1001/jama.2022.4983 https://jamanetwork.com/journals/jama/fullarticle/2791399

Guirguis-Blake JM, Evans CV, Perdue LA, Bean SI, Senger CA. Aspirin Use to Prevent Cardiovascular Disease and Colorectal Cancer: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2022;327(16):1585–1597. doi:10.1001/jama.2022.3337 https://jamanetwork.com/journals/jama/fullarticle/2791401


The decision to initiate low-dose aspirin use for the primary prevention of CVD in adults aged 40 to 59 years who have a 10% or greater 10-year CVD risk should be an individual one. Evidence indicates that the net benefit of aspirin use in this group is small. Persons who are not at increased risk for bleeding and are willing to take low-dose aspirin daily are more likely to benefit.

Strength of Recommendation

Grade B

Quality of Evidence

See full recommendation report for details, available here.

Artifact Decision Notes

Decision notes are included in the Implementation Guide.

Artifact Representation
  • Trigger Type: Data event
  • Trigger Event: A new 10-Year CVD risk score is documented in an outpatient setting
Patient is >=40 and <=59 years of age
MOST RECENT 10-Year CVD risk score >=10% in the past 6 years
Diagnosis of CVD
OR currently receiving aspirin (at any dose)
OR ordered for or receiving palliative care
OR aspirin allergy
OR evidence of increased risk of bleeding, represented by:
      Diagnosis of active gastrointestinal (GI) bleed
      OR diagnosis of active GI ulcers
      OR diagnosis of bleeding disorders
      OR diagnosis of end stage renal disease (ESRD)
      OR dialysis within the past 7 days
      OR diagnosis of cirrhosis
      OR MOST RECENT alanine transaminase (ALT) result is > 150
      OR diagnosis of thrombocytopenia
      OR currently receiving an anticoagulant
      OR currently receiving non-steroidal anti-inflammatory medications (NSAIDs)
      OR MOST RECENT systolic blood pressure (SBP) >= 160 millimeters/mercury (mmHg)
Interventions and Actions

NOTIFY clinician that aspirin therapy may be considered.

If CVD risk score >=10% and patient age 40-59:
Recommendation: Discuss oral aspirin 81mg daily if patient is NOT at high risk for bleeding
Rationale: CVD risk score >10% and age 50-59 without evidence of exclusions


DISPLAY link to shared decision making resource.


DISPLAY link to U.S. Preventative Services Task Force guidelines.

  DISPLAY link to education materials that are relevant to the patient's plan of care
  REQUEST medication order
  DOCUMENT any new medications on the active medication list
  DOCUMENT provider response if a reason for not prescribing aspirin is provided
Testing Experience
Pilot Experience

This artifact has not been tested in a clinical setting.