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.
Who Should Be Taking Aspirin To Prevent Heart Attacks
This is perhaps the most critical question we have: Who are the right people for aspirin therapy? said Dr. Chugh. First, lets identify those patients we know are going to benefit: patients whove already had a heart attack or a stroke, or already have evidence of significant plaque. Whether it be the carotid artery or blood vessels in the legsknown as peripheral arterial diseasethose patients would certainly benefit from a daily low-dose aspirin. The data here is fairly cut and dry. But where the real question is, is it a good preventive care choice for patientsthats where we have our questions.
For adults under 60, a heart scan may be able to predict who may benefit most from aspirin therapy, Dr. Chugh said.
Data is showing us that this is a very promising approach, he said. When someone has significant calcium in the blood vessels of the heart, we take a calcium score. And if thats greater than 100, which falls in the moderate risk category, then that patient may benefit from aspirin therapy.
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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Poonam Chhibber Md Explains The Recent Changes
Low-dose aspirin has long been recommended as a safe and inexpensive way to reduce the risk of cardiovascular disease , heart attacks, strokes and blood clots. In October, the U.S. Preventive Services Task Force changed these long-held recommendations, raising many questions for patients. Heres what you need to know.
What has changed
People aged 60 and older who do not have cardiovascular disease are now strongly discouraged from starting daily aspirin therapy to prevent a first heart attack or stroke.
Why did the aspirin recommendations change?
New research found that the risks of daily aspirin begin to outweigh the benefits starting at age 60. Specifically, the risk of aspirin causing potentially life-threatening bleeding in the brain or gastrointestinal tract increases with age. A review of the literature found that the incidence of these bleeding complications outnumbered preventive effects for people over 60 without established CVD.
What has not changed
Aspirin still has clear benefits for many people who already have cardiovascular disease or who are at high risk for it. These include:
- People with acute coronary artery syndrome
- People with acute occlusive stroke
- People with stable ischemic heart disease, carotid artery disease or peripheral artery disease
If youre already taking aspirin, should you stop?
If youre younger than 60, is it OK to start aspirin?
Are There Other Benefits To Taking Daily Aspirin
Some studies suggest that daily aspirin therapy may prevent certain cancers.
In particular, the 2016 USPSTF recommendations reported that taking aspirin on a daily basis likely reduces risk for colorectal cancer, but only after 5 to 10 years of use.
- are at risk of hemorrhagic stroke
- drink alcohol on a regular basis
- need to undergo routine dental or medical procedures
- are over the age of 70
If you have any of the above risk factors, its critical to talk with your doctor before taking aspirin.
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Fact: Once Your Doctor Decides That Daily Use Of Aspirin Is For You Safe Use Depends On Following Your Doctor’s Directions
There are no directions on the label for using aspirin to reduce the risk of heart attack or clot-related stroke. You may rely on your health professional to provide the correct information on dose and directions for use. Using aspirin correctly gives you the best chance of getting the greatest benefits with the fewest unwanted side effects. Discuss with your health professional the different forms of aspirin products that might be best suited for you.
Aspirin has been shown to lower the risk of heart attack and stroke in patients who have cardiovascular disease or who have already had a heart attack or stroke, but not all over-the-counter pain and fever reducers do that. Even though the directions on the aspirin label do not apply to this use of aspirin, you still need to read the label to confirm that the product you buy and use contains aspirin at the correct dose. Check the Drug Facts label for “active ingredients: aspirin” or “acetylsalicylic acid” at the dose that your health professional has prescribed.
Remember, if you are using aspirin everyday for weeks, months or years to prevent a heart attack, stroke, or for any use not listed on the label without the guidance from your health professional you could be doing your body more harm than good.
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Since then, clinical inertia the slow adoption of new practices by doctors poor communication, and unclear guidance have meant aspirin is still commonly used by those who are not at major risk of developing cardiovascular disease, Nissen said. Over the decades, several groups, such as the American Academy of Family Physicians, the American College of Cardiology, and the American Heart Association, as well as the FDA itself, have disagreed on who low-dose aspirin can help, and how much it can help them. The task force still leaves the decision of whether to use aspirin for prevention up to individuals and their doctors especially for those 40 to 59 years old but refutes the old idea that the drug is totally harmless, Nissen said.
Group by group, bit by bit, people have come around to the idea that the risks are about equivalent to its benefits for most people, Nissen told STAT.
To arrive at its recommendation, the task force reviewed 13 randomized clinical trials on the benefits and risks of aspirin use for preventing the development of cardiovascular disease or dying from it. They found aspirin use was associated with a lower risk of heart attack and stroke but not cardiovascular mortality or all-cause mortality.
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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.
Other Related Uspstf Recommendations
The USPSTF has made several other recommendations on CVD prevention, including statin use to prevent CVD,15 smoking cessation,16 counseling to promote a healthful diet and physical activity in persons with and without cardiovascular risk factors,17,18 and interventions to prevent obesity-related morbidity and mortality,19 as well as screening for high blood pressure20 and diabetes.21 The USPSTF has also made a recommendation on screening for colorectal cancer .22
This recommendation replaces the 2016 USPSTF recommendation on aspirin use to prevent CVD and CRC.23 In 2016, the USPSTF recommended 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, and that the decision to initiate low-dose aspirin use in adults aged 60 to 69 years who have a 10% or greater 10-year CVD risk should be an individual one. The USPSTF previously found that the evidence was 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 or adults 70 years or older.
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Fact: Aspirin Is A Drug
If you are at risk for heart attack or stroke your doctor may prescribe aspirin to increase blood flow to the heart and brain. But any drug including aspirin can have harmful side effects, especially when mixed with other products. In fact, the chance of side effects increases with each new product you use.
New products include prescription and other over-the-counter medicines, dietary supplements , and sometimes foods and beverages. For instance, people who already use a prescribed medication to thin the blood should not use aspirin unless recommended by a health professional. There are also dietary supplements known to thin the blood. Using aspirin with alcohol or with another product that also contains aspirin, such as a cough-sinus drug, can increase the chance of side effects.
Your health professional will consider your current state of health. Some medical conditions, such as pregnancy, uncontrolled high blood pressure, bleeding disorders, asthma, peptic ulcers, liver and kidney disease, could make aspirin a bad choice for you.
Make sure that all your health professionals are aware that you are using aspirin to reduce your risk of heart attack and clot-related strokes.
Benefits Of Preventive Medication
The USPSTF considered 13 randomized clinical trials involving 161,680 participants that reported on the benefits of aspirin use for the primary prevention of cardiovascular morbidity and mortality.14,25 Most trials used low-dose aspirin of 100 mg/d or less or aspirin every other day and included a balanced number of male and female participants and a broad distribution of ages, with mean age ranging from 53 years in the Physicians’ Health Study28 to 74 years in the Aspirin in Reducing Events in the Elderly trial.24
The evidence showed that aspirin use for primary prevention of CVD was associated with a decreased risk of myocardial infarction and stroke but not cardiovascular mortality or all-cause mortality. Results were similar when including studies using all doses of aspirin compared with studies using low-dose aspirin.14 Since low-dose aspirin is most relevant to current practice, the analyses below report outcomes pooling studies of low-dose aspirin use. Pooled effect estimates of studies using low-dose aspirin were also used to inform the parameters and assumptions of the microsimulation modeling study.26,27
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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.
Immediate First Aid Works To Minimize Blood Clotting Triggered By Plaque Ruptures
How should you take aspirin for a heart attack? You’ve always been healthy, but you seemed to run out of steam at your wife’s 60th birthday dinner last week. And now your chest feels heavy, as if you’re in a vise. You take some antacids, even though it’s 7:00 a.m. and you haven’t even had breakfast. But you get no relief, and the pain is spreading to your jaw and shoulder. You call your wife, who takes one look at you and rushes to the phone. After calling 911, she brings you an aspirin and some water.
Your wife got it right: You may be having a heart attack, and you need to get to the hospital fast. You also need to get some aspirin into your system quickly but should you chew the tablet or swallow it?
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The Task Force’s Updated Guidelines Recommend Against Starting Low
A new report released by the United States Preventive Services Task Force on Tuesday states taking low-dose aspirin on regular basis has little to no benefit for most adults suffering from heart problems.
In fact, scientists believe that it can lead to internal bleeding inside the stomach or brain as people get older.
Heart attacks are responsible for one in four deaths in the United States making them the lead cause of mortality.
Every year, at least 6,10,000 people experience their first stroke in the US while nearly 6,05,000 suffer their first myocardial infarction.
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The USPSTF conducted the study on adults who were older than 40 years and did not have any symptoms of Cardiovascular disease .
The people tested between the age of 40 to 50 years had a 10 per cent or greater 10-year CVD risk which has a small net benefit.
The task force’s updated guidelines recommend against starting low-dose aspirin use for the prevention of heart attack in adults who are above 60-years-old.
According to cardiologist Steven Nissen, If youre taking an aspirin a day and you get in a motor vehicle accident, youre going to bleed more.
He is the chief academic officer of the Heart, Vascular, and Thoracic Institute at the Cleveland Clinic.
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Response To Public Comment
A draft version of this recommendation statement was posted for public comment on the USPSTF website from October 12 to November 8, 2021. In response to public comment, the USPSTF wants to restate that the focus of this recommendation is the use of aspirin for the primary prevention of CVD and not for other indications. This recommendation only applies to persons who do not have a history of CVD, signs or symptoms of CVD, or other conditions for which aspirin may be indicated. Persons who are currently taking aspirin and have questions about why they are taking it, or whether they should continue or discontinue aspirin use, should discuss these questions with their clinician. Persons who are taking aspirin should not discontinue using it without consulting their clinician. For persons who are deciding with their clinician whether to continue or discontinue taking aspirin for primary prevention, clinicians may want to consider that persons age, level of CVD risk and bleeding risk, preferences, and reasons for taking aspirin.
More research is needed to evaluate the following.
Funding/Support: The USPSTF is an independent, voluntary body. The US Congress mandates that the Agency for Healthcare Research and Quality support the operations of the USPSTF.
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Aspirin For Heart Attack First Aid
The reason you need aspirin is the same reason you should call 911 without delay: A heart attack is a dynamic event, and early intervention can limit the damage. The paramedics can give you oxygen and medication, and they’ll monitor your blood pressure and heart rhythm to forestall complications as they speed you to the ER. In the hospital, doctors will take EKGs and blood tests to see if you are having a heart attack if so, they will usually try to open the blocked artery with an angioplasty and stent or, if that’s not available, with a clot-busting drug.
It’s modern cardiology at its best, and it has improved considerably the outlook for heart attack victims. But how can a humble aspirin tablet add to high-tech medicine, and why is speed so important?
Most heart attacks develop when a cholesterol-laden plaque in a coronary artery ruptures. Relatively small plaques, which produce only partial blockages, are the ones most likely to rupture. When they do, they attract platelets to their surface. Platelets are the tiny blood cells that trigger blood clotting. A clot, or thrombus, builds up on the ruptured plaque. As the clot grows, it blocks the artery. If the blockage is complete, it deprives a portion of the heart muscle of oxygen. As a result, muscle cells die and it’s a heart attack.