Aspirin Use To Prevent 1st Heart Attack Or Stroke Should Be Curtailed Us Panel Says
Adults at high risk for cardiovascular disease may face serious side effects if they start a daily regimen of low-dose aspirin.
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Doctors should no longer routinely start most people who are at high risk of heart disease on a daily regimen of low-dose aspirin, according to new draft guidelines by a U.S. panel of experts.
The proposed recommendation is based on mounting evidence that the risk of serious side effects far outweighs the benefit of what was once considered a remarkably cheap weapon in the fight against heart disease.
The U.S. panel also plans to retreat from its 2016 recommendation to take baby aspirin for the prevention of colorectal cancer, guidance that was groundbreaking at the time. The panel said more recent data had raised questions about the benefits for cancer, and that more research was needed.
On the use of low-dose or baby aspirin, the recommendation by the U.S. Preventive Services Task Force would apply to people younger than 60 who were at high risk of heart disease and for whom a new daily regimen of the mild analgesic might have been a tool to prevent a first heart attack or stroke. The proposed guidelines would not apply to those already taking aspirin or those who have already had a heart attack.
Those who are already taking baby aspirin should talk to their doctor.
If I Should Not Be Taking Baby Aspirin But Previously Started Doing So Is It Safe To Stop Suddenly
Yes. Unlike some medications which you should not stop taking abruptly, it is safe to stop taking low-dose aspirin without weaning off of it.
If you are someone who should stop taking a daily low-dose aspirin, then you can stop it without weaning, Simon said.
But, he urges caution for anyone whose doctor previously recommended a daily baby aspirin.
I would not stop it without first talking with whoever prescribed it, he said.
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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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.
Most Adults Should Not Take Daily Low
- The U.S. Preventive Services Task Force updated its recommendations on who should and should not be taking daily low-dose aspirin
- The task force says adults over aged 60 who are at increased risk of a heart attack or stroke, but have not suffered either, should not take baby aspirin
- Officials say this is because the bleeding risks far outweigh any potential benefits from daily aspirin
- Daily low-dose aspirin can still be taken by patients who already have had a heart attack or stroke or younger adults without bleeding risks
- The UPSTF also backtracked on guidance that a daily baby aspirin should be taken to prevent colorectal cancer for adults in their 50s and 60s
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How Should I Take It
First, tell your doctor if you are allergic to aspirin, ibuprofen, or naproxen. If you get the go-ahead to start an aspirin routine, then:
- Donât take it on an empty stomach. Take aspirin with a full glass of water with meals or after meals to prevent stomach upset.
- Donât break, crush, or chew extended-release tablets or capsules — swallow them whole. Chewable aspirin tablets may be chewed, crushed, or dissolved in a liquid.
- Aspirin should never be taken in place of other medications or treatments recommended by your doctor.
- Never take it with alcohol. That increases your chance of stomach bleeding.
Ask your doctor what other medicines you can take for pain relief or minor colds while you take aspirin. Read the labels of all pain relievers and cold products to make sure theyâre aspirin-free. Other drugs with aspirin or nonsteroidal anti-inflammatory drugs may cause bleeding when taken with your regular aspirin therapy.
Before any surgery, dental procedure, or emergency treatment, tell the doctor or dentist that youâre taking aspirin. You might need to stop taking it for 5 to 7 days before your procedure.
However, donât stop taking this medicine without first consulting with your doctor.
Aspirin In Secondary Prevention
Patients who suffer from one or more CVD events, such as myocardial infarction or ischemic stroke, are at very high risk for another CVD event. While rescue procedures, such as percutaneous coronary intervention , are aimed at stabilizing acute events, aspirin therapy may actually serve to prevent subsequent CVD events. The role of aspirin in reducing CVD mortality and repeat events after acute MI was first demonstrated in the second International Study of Infarct Survival trial.7 In this study, 17,187 patients from 417 hospitals were enrolled within 24 hours after onset of suspected acute MI and randomized to receive: a 1-hour intravenous infusion of 1.5 MU of streptokinase one month of 160 mg/day enteric-coated aspirin both treatments or neither. Aspirin use resulted in a significant reduction in non-fatal reinfarction, stroke, 5-week vascular mortality, and all-cause mortality.7 Although other, smaller trials showed similar benefits for patients with a history of previous MI, the ISIS-2 trial was the first to provide evidence of a direct effect of aspirin on acute MI, demonstrating that one month of low-dose aspirin started immediately after MI in 1000 patients would prevent 25 deaths and 10 to 15 nonfatal infarcts and strokes. Additional mortality benefits were observed with longer duration of aspirin therapy.7
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Study: A Daily Baby Aspirin Has No Benefit For Healthy Older People
Aspirin use can cause serious harms, and risk increases with age, he said.
If finalized, the advice for older adults would backtrack on recommendations the panel issued in 2016 for helping prevent a first heart attack and stroke, but it would be in line with more recent guidelines from other medical groups.
Doctors have long recommended daily low-dose aspirin for many patients who already have had a heart attack or stroke. The task force guidance does not change that advice.
The task force previously said a daily aspirin might also protect against colorectal cancer for some adults in their 50s and 60s, but the updated guidance says more evidence of any benefit is needed.
The guidance was posted online to allow for public comments until Nov. 8. The group will evaluate that input and then make a final decision.
Health
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 re-analysis 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.
How Much Should I Take
Research says between 80 milligrams and 160 milligrams per day. This is less than half of the standard 325-milligram aspirin most people are prescribed.
Many studies show the lower dose works just as well as the higher dose. It also drops your risk of internal bleeding. A baby aspirin contains 81 milligrams. There are other lower-dose adult aspirins available.
Check with your doctor first to find out what dose is right for you.
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Is Baby Aspirin Good For Heart Disease
Daily aspirin therapy may lower your risk of heart attack and stroke, but daily aspirin therapy isn’t for everyone. Is it right for you?
You should consider daily aspirin therapy only if you’ve had a heart attack or stroke, or you have a high risk of either. And then, only take aspirin with your doctor’s approval. Although taking an occasional aspirin or two is safe for most adults to use for headaches, body aches or fever, daily use of aspirin can have serious side effects, including internal bleeding.
But this clotting can also happen within the vessels that supply your heart and brain with blood. If your blood vessels are already narrowed from atherosclerosis – the buildup of fatty deposits in your arteries – a fatty deposit in your vessel can burst. Then, a blood clot can quickly form and block the artery. This prevents blood flow to the heart or brain and causes a heart attack or stroke. Aspirin therapy reduces the clumping action of platelets – possibly preventing heart attack and stroke.
For men of all ages, aspirin can:
- Prevent a first and second heart attack
For women younger than 65, aspirin can:
- Prevent a first stroke
For women 65 and older, aspirin can:
- Prevent a first and second heart attack
- Prevent a first stroke
- Reduce heart disease risk
The risk of bleeding with daily aspirin therapy, however, is about the same in both sexes.
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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Aspirin As A Primary Prevention Measure
The suggested changes say that no one over the age of 60 should take aspirin as primary prevention against cardiovascular disease. Primary prevention is a term for avoiding a first heart attack, ischemic stroke or other type of cardiovascular issue. Low-dose aspirin might be considered for individuals age 40 to 59 who are at moderate risk of developing cardiovascular disease and do not have an increased risk of bleeding.
Bitar says his moderate- to high-risk patients are evaluated using the Framingham scoring system, which helps to predict a persons risk of heart attack and stroke. The system measures factors like HDL cholesterol, total cholesterol, blood pressure, age, sex and smoking habits, he said.
For years, aspirin was considered a safe way to prevent heart disease because it served as an over-the-counter medication that thins the blood, thus reducing the risk of clot formation a precursor of heart attack and stroke. But experts now warn about the risk of internal bleeding from consuming aspirin.
Taking aspirin on a daily basis irritates the lining of the stomach and bowels, which can lead to bleeding in the digestive system, said Bitar. For those who have not experienced a cardiovascular event, the benefits of a daily aspirin do not outweigh the risk of bleeding, he says.
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.
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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 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:
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The stakes are high: Heart disease is the leading cause of death in the United States, and is the cause of more than 1 in 4 deaths killing more Americans than cancer, Covid-19, and Alzheimer disease in 2021. More than 1 million Americans have their first heart attack or stroke each year, statistics from the American Heart Association show.
Black people are more likely to develop cardiovascular disease than non-Black people, although the report notes race is a social construct and an imperfect proxy for social determinants of health and the effects of structural racism, so some calculations of risk may be inaccurate. Sex is another risk factor. Those assigned male at birth bear the brunt of cardiovascular disease and its effects on quality of life, but those assigned female at birth are more likely to die from cardiovascular issues, including stroke, which they experience later in life than men.
The task forces analysis found that the benefits of aspirin for preventing cardiovascular disease is about the same for doses from 50 milligrams to 500 milligrams. The dose recommended by the USPSTF is 81 milligrams, the most commonly prescribed amount in the United States. The task force continued to support its position that there is little evidence that low-dose aspirin prevents colorectal cancer, and that as with cardiovascular disease the harms may outweigh the benefits.