Aspirin No Longer Recommended To Prevent 1st Heart Attack Stroke For Most Adults Over 60
The new guidelines do not change for people who have had a heart attack.
For years, doctors recommended people in their 50s start taking baby aspirin every day to protect against heart attacks and stroke. But in recent years, with new evidence of the possible harm of daily aspirin, health experts shifted those recommendations.
In major new guidance, an influential physician task force no longer recommends daily aspirin to prevent a first heart attack or stroke among people 60 and older. Meanwhile, the new guidance said people 40 to 59 should only take it if they have a high risk of cardiovascular disease, and in consultation with a doctor. There is little benefit in continuing aspirin beyond the age of 75 years old, experts concluded.
The new guidance comes from the United States Preventive Services Task Force , an influential physician group that helps guide medical best practices.
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It might be time to rethink that daily aspirin regimen.
US health experts have urged a revision to the routine prescription of daily, low-dose aspirin to prevent heart attack and stroke, as studies now show that the practice may put healthy adults at risk of other serious complications.
The US Preventive Services Task Force submitted a draft of new recommendations on Tuesday, which remain in review by peer researchers through Nov. 8.
The panels report maintained that low-dose aspirin, at 81-100 milligrams per dose, can reduce the risk of cardiac events and stroke, but at the same time increases major GI bleeding, extracranial bleeding and intracranial bleeding, they wrote.
Evidence also points to a long-term reduction in the incidence of colorectal cancer and mortality, but results are limited as to whether the benefits outweigh the risks for healthy patients with no previous signs of heart disease.
The new instructions would apply in particular to those aged 60 and below who are considered high risk for heart disease or stroke. Meanwhile, those on a daily aspirin regimen due to a prior heart attack should decide with a physician whether they should continue.
Cardiac history aside, the national task force now discourages anyone older than 60 to reconsider taking the daily dose, as bleeding risks increase significantly with age.
New Advice On Aspirin And Heart Health
Who is affected?
If finalized, the recommendation would affect most people in their 40s and 50s whose doctors might have prescribed low-dose aspirin as a preventive tool in the past. For years, people were advised to take a daily pill to try to avoid a first heart attack or stroke. Patients with questions should talk to their doctors.
The task force also said that no one over 60 should take low-dose aspirin as a new treatment if they have not had a heart attack or stroke.
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Is There More Harm Than Benefit
Previous guidelines from the United States Preventive Services Task Force warned against taking aspirin for the primary prevention of heart disease unless youre at an elevated risk typically if youre 50 to 69 years old with a 10 percent or greater chance of having a heart attack or stroke within the next 10 years.
There is good reason to be wary of aspirin, warns Michos, particularly for women. The Womens Health Study was a large trial that looked at whether women with no history of heart disease would benefit from taking a low dose of aspirin. Researchers found that in the overall group of women, aspirin didnt reduce the risk of heart attacks, but it did increase the risk of bleeding. Some benefit was seen for women over the age of 65.
So not only was there lack of benefit for the younger women taking aspirin, but there was also a question of harm, says Michos. Its important for people to realize that just because aspirin is over-the-counter does not mean it is necessarily safe. Many patients take aspirin because they think its good for their hearts, but it carries some serious risks.
The best way to assess your risk level is to talk to your doctor about it. Your doctor can help you weigh the risks and benefits to determine if low dose aspirin therapy is right for you.
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The independent panel of disease-prevention experts analyzes medical research and literature and issues periodic advice on measures to help keep Americans healthy. Newer studies and a reanalysis of older research prompted the updated advice, Wong said.
Aspirin is best known as a pain reliever but it is also a blood thinner that can reduce chances for blood clots. But aspirin also has risks, even at low doses mainly bleeding in the digestive tract or ulcers, both of which can be life-threatening.
Lauren Block, an internist-researcher at Feinstein Institutes for Medical Research in Manhasset, N.Y., said the guidance is important because so many adults take aspirin even though they have never had a heart attack or stroke.
Block, who is not on the task force, recently switched one of her patients from aspirin to a cholesterol-lowering statin drug because of the potential harms.
The patient, 70-year-old Richard Schrafel, has high blood pressure and knows about his heart attack risks. Schrafel, president of a paperboard-distribution business, said he never had any ill effects from aspirin, but he is taking the new guidance seriously.
Rita Seefeldt, 63, also has high blood pressure and took a daily aspirin for about a decade until her doctor told her two years ago to stop.
He said they changed their minds on that, recalled the retired elementary school teacher from Milwaukee. She said she understands that science evolves.
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The new recommendations were aimed at people who have not yet started taking a daily aspirin. The panel of experts did not issue guidance for people who are already taking a daily aspirin, and the updated news does not necessarily mean people should stop taking it if prescribed by a doctor.
“We want to emphasize that these recommendations are focused on starting aspirin to prevent a first heart attack or stroke. Anyone who already takes aspirin and has questions about it should speak with their healthcare professional,” Wong said.
The new guidelines do not change for people who have had a heart attack, stroke or other major cardiovascular issue. The recommendation for using aspirin to protect them from a second event remains strong.
Recommendations on daily aspirin to prevent disease have shifted in recent years. In 2016, the preventive services task force recommended people in their 50s at risk for heart disease take baby aspirin to prevent both cardiovascular disease and colon cancer. But updated recommendations based on additional research found benefits may not outweigh the risk, concluding the best colon cancer prevention is routine screening beginning at the age of 45.
Dr. Chineze Akusoba is an Internal Medicine resident at the Mayo Clinic Rochester, Minnesota, and a contributor on the ABC News Medical Unit.
Should I Take A Daily Aspirin Or Not
The decision to use aspirin therapy for those ages 40 to 70 is complicated. Bottom line: Talk to your doctor before starting. If you were put on an aspirin regimen for primary prevention, but dont have a history of heart disease, dont just stop cold turkey either. Instead, talk to your doctor about whether you still need to be taking it or not.
The decision regarding aspirin for primary prevention among healthy patients should be individualized based on patient preference after discussion of the potential benefits and risks, Dr. Henry said. Practitioners and patients should have discussions which include patient values and preferences regarding cardiovascular disease, colorectal cancer and major bleeding. While many tools are available to estimate benefits and risks of disease, they all have limitations.
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Aspirin May Be Only Minimally Beneficial And Comes With An Increased Risk Of Digestive Tract Bleeding Says Ucla Health Cardiologist Dr Boback Ziaeian
A panel of disease-prevention experts says older adults who dont have heart disease should not take daily low-dose aspirin to prevent a first heart attack or stroke, a shift from earlier guidance.
The U.S. Preventive Services Task Force, a panel of physicians who review scientific research to develop guidelines to improve Americans health, published new recommendations on April 26 advising against daily aspirin use for the prevention of cardiovascular disease in people age 60 and older.
Taking baby aspirin daily has been routine for millions of Americans looking to prevent a heart attack or stroke. Aspirin has blood-thinning properties that can reduce the likelihood of blood clots forming in the arteries. But these same properties can also cause ulcers and bleeding in the digestive tract.
The task force says in its new recommendations that low-dose daily aspirin to prevent cardiovascular disease has a modest benefit for people ages 40 to 59 who arent at increased risk for bleeding.
It concludes that there is no net benefit of taking aspirin for primary prevention of heart disease in those 60 and older.
These updated recommendations are based on three recent randomized control trials finding that using aspirin for primary prevention of heart attack and stroke showed no meaningful benefits and higher bleeding risks, says Boback Ziaeian, MD, PhD, assistant professor in the division of cardiology at the David Geffen School of Medicine at UCLA.
Aspirin And Gender Differences
Well known differences exist in the epidemiology of vascular events in men and women. Men are more prone to stroke and MI, yet women are more likely to die from these events than men.12 Similarly, meta-analysis results suggest that there are also gender differences in the effects of aspirin on CVD, whereby risk of MI appears to be reduced in men and risk of stroke appears to be reduced in women.28,37 Current guidelines for the use of aspirin for CVD prevention take these differences into consideration. Aspirin use in males is primarily intended for the prevention of coronary artery disease, while in females, prevention of stroke is the main target.12 The reason for differences in the effect of aspirin therapy by gender is currently unknown, but evidence suggests that there may be some biological basis for these differences. For example, baseline platelet reactivity is greater in women than in men, with higher residual reactivity following aspirin treatment in women.38 As such, physicians should also be sure to consider gender-specific risks, benefits, and guidelines for aspirin therapy prior to making patient recommendations.
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What Precautions Do I Need To Take
Limit alcohol
Drinking 3 or more alcoholic drinks every day while taking daily aspirin increases your risk for liver damage and stomach bleeding. If your doctor recommends aspirin, limit or stop alcohol usage.
Talk to doctor before a surgery or procedure
Before having a surgery or procedure that may cause bleeding, tell your doctor or dentist that you take aspirin. Aspirin may cause you to bleed more than usual. He or she will tell you if you should stop taking aspirin before your surgery or procedure. Make sure that you understand exactly what your doctor wants you to do.
Do not suddenly stop taking aspirin without talking to your doctor first. Talking to your cardiologist first is especially important if you have had a stent placed in a coronary artery.
Tell your doctor if you notice that you bruise easily or have other signs of bleeding. These include bloody or black stools or prolonged bleeding from cuts or scrapes.
Tell your doctor about all your medicines
Aspirin should not be taken with many prescription and over-the-counter drugs, vitamins, and natural health products. So before you start aspirin therapy, talk to your doctor about all the drugs and other remedies you take.
Be careful taking pain relievers
Take NSAIDs safely. If you need both aspirin and an NSAID pain reliever every day, talk to your doctor first. Ask your doctor what pain reliever you should take. You may be able to use another type of pain reliever, such as acetaminophen, to treat your pain.
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The AHA also called attention to bleeding risk in older patients facilitated by aspirin, a type of blood thinner and anticoagulant, as seen in previous studies.
Dr. Jeffrey Berger, director of the Center for the Prevention of Cardiovascular Disease at NYU Langone Health, called the trend shocking in an interview with The Post at the time. His lab studies blood platelets and coagulation as an indicator of heart health.
The fact that many people use aspirin without consulting their health-care provider is shocking, and likely results from the perception that aspirin has little downside, he said.
The AHAs guidelines, similar to the US Preventive Services Task Force update, see that adults over 70 without heart disease, and younger than 40 with increased risk of bleeding, should avoid regular doses of aspirin. Anyone outside those groups should consult their doctor first.
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Is Daily Aspirin Right For You
Doctors typically prescribe daily aspirin therapy for people who have certain cardiovascular risk factors.
You might benefit from taking aspirin every day if you answer yes to one or more of the following questions:
- Have you previously had a heart attack?
- Have you previously had a clot-related stroke?
- Have you had a stent inserted in a coronary artery?
- Do you have chest pain caused by angina?
- Have you had coronary bypass surgery?
- Are you a man over 50 or a woman over 60 with diabetes and at least one other heart disease risk factor?
- Do you have a family history of heart attacks?
If you think youre at risk, make an appointment to discuss daily aspirin with a doctor.
Why Take Aspirin For A Heart Attack
A heart attack results from a blockage or clot in the arteries leading to the heart. When this happens, the surrounding heart tissue can’t get oxygen, and that tissue can die and weaken the heart. That’s why it’s essential for medical professionals to quickly remove that clot.
You should immediately call 911 if you think you may be experiencing a heart attack. But once you’re on the line with a 911 operator, they might recommend taking an aspirin because it thins the blood and thus makes it harder for further clots to form.
Taking aspirin in the middle of a heart attack is “critical for preventing the heart attack from getting worse,” says Geoffrey Barnes, MD, a cardiologist at University of Michigan Medicine.
A 911 operator might recommend you take one adult-strength aspirin or two to four low-dose aspirin in the middle of a heart attack, according to the American College of Cardiology. One study found that taking aspirin during a heart attack reduced mortality by 23%.
“I would say that aspirin has been at the center of our treatment for heart attacks for decades,” Barnes says. “It is perhaps the most important or one of the most important things we do, and we have been recommending it to people for a very long time.”
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Where Do The Experts Stand On Daily Aspirin
The recommendations come from an independent panel of experts in disease prevention and evidence-based medicine called the U.S. Preventive Services Task Force . The group has revamped its 2016 guidelines on aspirin after reviewing newer studies. In 2021, it released a draft version of proposed changes and made them available for public comment.
Now, the task force has published its final recommendations:
- People 40 to 59 years old who are at higher risk for heart disease or stroke and donât have a history of either condition should talk to their doctor about whether they should start taking aspirin as preventive step.
- People 60 and older shouldnât start taking aspirin to prevent a first heart attack or stroke. The task force says the risk of internal bleeding due to aspirin, which rises with age and can be life-threatening, cancels out the benefits of preventing heart problems in people 60 and older.
These recommendations arenât meant for everyone, the USPSTF says. Ask your doctor what you should do if you:
- Already have heart disease
- Have had a stroke
- Are already taking aspirin
If youâre already taking aspirin because youâve had a heart attack or stroke, donât stop taking it unless your doctor tells you to, the task force says.
Why Prescription Medications May Not Be Enough
If you take prescription medications for high blood pressure, high cholesterol, and diabetes, they may not be enough to protect your heart. Talk to your doctor about whether these medications are enough for you and whether adding an aspirin regimen can help further reduce the risk of another heart attack or clot-related stroke.
Aspirin is not appropriate for everyone, so be sure to talk to your doctor before you begin an aspirin regime.
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What Are The Guidelines For Aspirin Therapy
Always talk to your healthcare provider before starting aspirin therapy for heart disease. Your provider will tell you whether aspirin is good for your heart and how much you should take.
One baby aspirin per day is enough to help prevent heart attack or stroke. Higher doses will increase your risk of bleeding. If you do not have many risk factors for heart disease, are older, or have a high risk of life-threatening bleeding, then aspirin therapy may not be right for you.