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?
The takeaway
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Heart disease and stroke are the leading causes of death in the United States, accounting for more than one in four deaths. While daily aspirin use has been shown to lower the chance of having a first heart attack or stroke, it can also increase the risk for bleeding in the brain, stomach and intestines. Although the absolute risk of a bleeding event is low, the risk increases with age.
“Based on current evidence, the task force recommends against people 60 and older starting to take aspirin to prevent a first heart attack or stroke,” task force vice chair Dr. Michael Barry, professor of Medicine at Massachusetts General Hospital, told ABC News. “Because the chance of internal bleeding increases with age, the potential harms of aspirin use cancel out the benefits in this age group.”
“People who are 40 to 59 years old and dont have a history of cardiovascular disease but are at higher risk may benefit from starting to take aspirin to prevent a first heart attack or stroke,” task force member Dr. John Wong, interim Chief Scientific Officer and Professor of Medicine at Tufts Medical Center, told ABC News. “Its important that they decide together with their healthcare professional if starting aspirin is right for them because daily aspirin does come with possible serious harms.”
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.
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Guidance Is Changing On Low
Many adults have been advised by their doctors to take low-dose aspirin to prevent heart disease. But the guidance is changing, as newer research shows the benefits of daily aspirin do not outweigh the risks for some patients. If youre taking aspirin for prevention, you may want to talk with your doctor.
Aspirin helps prevent clots from forming in the blood vessels, which can cause heart attack or stroke. However, the new recommendations are based on research showing the risks of stomach bleeding in older adults outweigh the blood-thinning benefits of daily aspirin.
The Task Forces 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 forceâs 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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Should I Take Aspirin During A Heart Attack Or Stroke
The more important thing to do if any heart attack warning signs occur is to call 911 immediately. Don’t do anything before calling 911. In particular, don’t take an aspirin, then wait for it to relieve your pain. Don’t postpone calling 911. Aspirin won’t treat your heart attack by itself.
After you call 911, the 911 operator may recommend that you take an aspirin. He or she can make sure that you don’t have an allergy to aspirin or a condition that makes using it too risky. If the 911 operator doesn’t talk to you about taking an aspirin, the emergency medical technicians or the physician in the Emergency Department will give you an aspirin if it’s right for you.
Taking aspirin isn’t advised during a stroke, because not all strokes are caused by blood clots. Most strokes are caused by clots, but some are caused by ruptured blood vessels. Taking aspirin could potentially make these bleeding strokes more severe.
How Does Aspirin Work To Prevent A Heart Attack Or Stroke
Aspirin slows the blood’s clotting action by reducing the clumping of platelets. Platelets are cells that clump together and help to form blood clots. Aspirin keeps platelets from clumping together, thus helping to prevent or reduce blood clots.
During a heart attack, blood clots form in an already-narrowed artery and block the flow of oxygen-rich blood to the heart muscle . When taken during a heart attack, aspirin slows clotting and decreases the size of the forming blood clot. Taken daily, aspirin’s anti-clotting action helps prevent a first or second heart attack.
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Why Have Adults Been Taking Low
Cardiovascular disease is the leading cause of death in the U.S., accounting for about one in three deaths, according to the Preventive Services Task Force. Each year, an estimated 605,000 Americans have a first heart attack and about 610,000 experience a first stroke. So prevention is key. And, for decades, doctors have often advised older adults to take daily baby aspirin to prevent heart attacks and strokes.
How Do You Take Aspirin Safely
- Take aspirin with food.
If aspirin upsets your stomach, you can try taking it with food. But if that doesn’t help, talk with your doctor. Aspirin can irritate the stomach lining and sometimes cause serious problems.
- Talk to a doctor before a surgery or procedure
Before you have 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.
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.
- Seek help for signs of serious bleeding.
- A nosebleed that you can’t easily stop.
- Bloody or black stools, or rectal bleeding.
- Bloody or pink urine.
Aspirin should not be taken with many prescription and over-the-counter drugs, vitamins, herbal remedies, and supplements. So before you start aspirin therapy, talk to your doctor about all the drugs and other remedies you take.
Ask your doctor if you can drink alcohol while you take aspirin. And ask how much you can drink. Too much alcohol with aspirin can cause stomach bleeding.
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Fact: Daily Use Of Aspirin Is Not Right For Everyone
Aspirin has been shown to be helpful when used daily to lower the risk of heart attack, clot-related strokes and other blood flow problems in patients who have cardiovascular disease or who have already had a heart attack or stroke. Many medical professionals prescribe aspirin for these uses. There may be a benefit to daily aspirin use for you if you have some kind of heart or blood vessel disease, or if you have evidence of poor blood flow to the brain. However, the risks of long-term aspirin use may be greater than the benefits if there are no signs of, or risk factors for heart or blood vessel disease.
Every prescription and over-the-counter medicine has benefits and risks even such a common and familiar medicine as aspirin. Aspirin use can result in serious side effects, such as stomach bleeding, bleeding in the brain, and kidney failure. No medicine is completely safe. By carefully reviewing many different factors, your health professional can help you make the best choice for you.
When you don’t have the labeling directions to guide you, you need the medical knowledge of your doctor, nurse practitioner, or other health professional.
What Should Younger People Who Have A Risk Of Heart Disease Do
They should talk with their doctors and decide whether a daily dose of baby aspirin benefits them.
Patients ages 40 to 59 who have a greater than 10% risk of having a stroke or heart attack over 10 years should have a patient-centered discussion with their doctor about whether to start using aspirin. There may be a small net benefit for them. This should be a patient decision based on bleeding risk versus cardiovascular risk, Simon said.
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Whats The Bottom Line
The best way to know if you can benefit from aspirin therapy is to ask your health care provider. You should not start aspirin on your own.
Written by American Heart Association editorial staff and reviewed by science and medicine advisers. See our editorial policies and staff.
Last Reviewed: Mar 20, 2019
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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.
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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What Caused The Low
After last meeting on the topic in 2016, the USPSTF recently reconvened to discuss the role that low-dose aspirin should and shouldn’t play in the prevention of heart disease and its complications. New recommendations that were drafted and released in October 2021 are now finalized as of April 26, 2022.
The new recommendations set by the task force are that:
- Taking daily low-dose aspirin for primary prevention of heart disease in adults 60+ shows no clear benefit.
- Taking daily low-dose aspirin for primary prevention of heart disease in adults 40-59 who have a 10-year atherosclerotic cardiovascular disease risk of 10% or higher may have a small benefit.
“Primary prevention means you’re at risk for heart disease and preventive steps are needed to reduce this risk, but there’s no evidence that your arteries are actually diseased and you haven’t yet had a heart attack or stroke,” says Dr. Septimus.
Rather than taking low-dose aspirin every day, your doctor may recommend reducing your heart disease risk by making lifestyle changes, such as:
What Drug Interactions Should I Be Aware Of If Im On Aspirin Therapy
Tell your healthcare provider about any medications you take. Let your provider know if you take over-the-counter drugs, herbal supplements or vitamins. Some medications and supplements may thin your blood and could increase your bleeding risk if you also take aspirin therapy.
Before any procedure, emergency treatment or dental work, tell the provider that you are taking low-dose aspirin therapy.
Talk to your healthcare provider about using alcohol if you are on aspirin therapy. Drinking alcohol can increase your risk of stomach bleeding.
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How Do You Take It
Talk to your doctor before taking daily aspirin. It’s not right for everyone.
If you and your doctor decide that daily aspirin is right for you, your doctor will recommend a dose of aspirin and how often to take it. Low-dose aspirin is the most common dose used to prevent a heart attack or a stroke. A typical schedule is to take aspirin every day. Be sure you know what dose of aspirin to take and how often to take it.
Aspirin can cause serious bleeding. Be sure you get instructions about how to take aspirin safely.
Other Ways To Reduce Your Risk For Heart Disease
Although non-modifiable risk factors such as age and genetics weigh heavily on a persons chances of developing cardiovascular disease, there are measures individuals can take to reduce their risk factors. Bitar encourages his patients to incorporate lifestyle changes such as eating a healthy, plant-based or Mediterranean diet, getting regular exercise, avoiding smoking, improving sleep habits and reducing alcohol use.
Blood pressure control, weight loss and well-controlled diabetes are some of the other primary and, for many patients, secondary preventive measures that can significantly reduce your chances of cardiovascular disease altogether or help you avoid a second cardiovascular event, said Bitar.
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Get The Care You Need
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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.
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