Aspirin As A Preventive Measure
A healthcare professional may prescribe a daily low dosage of aspirin to prevent heart attacks.
One 2019 study found that people who regularly took aspirin had a 14% reduced risk of experiencing a first heart attack. However, the same study cautions against the widespread use of aspirin for this purpose. This is because regularly taking aspirin may increase the risk of major bleeding problems by 46%.
Also, a 2020 study concluded that the potential benefits of aspirin are not the same for everyone. For example, the researchers found that regular aspirin use only reduced the chances of a first heart attack for some people who had an increased risk of cardiovascular disease.
People with this increased risk include those who:
- currently smoke
- have a history of high blood pressure
- have a history of high blood cholesterol
So, while aspirin can help prevent a first heart attack for some people, this benefit may not be widespread.
What Is The Effect Of Aspirin Discontinuation On Cvd Mortality And Bleeding Outcomes
Rohan Khera: There is no clear evidence to suggest the effect of aspirin discontinuation on a large population of patients across multiple outcomes. That said, aspirin discontinuation should have modest effects on CVD risk and larger effects on bleeding, particularly gastrointestinal bleeding. Because the risk of these events is low, the most measurable difference that patients will notice is less bleeding from occasional cuts and bruises, such as while shaving.
Erica Spatz: It is important to note that the USPTF draft recommendations are not for people already taking aspirin either for primary or secondary prevention. We do not have studies to know whether stopping aspirin increases cardiovascular risk. With that said, this is a real opportunity for us to have discussions with our patients about their risk for cardiovascular disease and bleeding, to revisit the rationale for each of the medications they are taking, to eliminate medications that may be harmful or providing limited or no benefit , and to get buy-in for the medications we are using, especially as many are intended to be taken for a lifetime.
New Guidelines Change The Rules For This Longtime Heart Protection Practice In Certain Patients
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For years, many people have taken a low-dose aspirin every day to reduce the risk of heart attacks and strokes with their doctors blessing. But following new evidence that a daily baby aspirin may have more risks than benefits for some patients, the U.S. Preventive Services Task Force is revising its aspirin recommendation from 2016.
It now advises that many patients should not start taking low-dose aspirin, and that those who are on it should speak with their doctor.
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How To Cope With Side Effects
What to do about:
- mildindigestion – take your aspirin with food. If the indigestion still doesn’t go away, it could be a sign that the aspirin has caused a stomach ulcer. Talk to your doctor – they may prescribe something to protect your stomach or switch you to a different medicine.
- bleeding more easily than normal – be careful when doing activities that might cause an injury or a cut. Always wear a helmet when cycling. Wear gloves when you use sharp objects like scissors, knives, and gardening tools. Use an electric razor instead of wet shaving, and use a soft toothbrush and waxed dental floss to clean your teeth. See a doctor if you’re worried about any bleeding.
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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Who Should Not Take Aspirin
People who have certain health problems shouldn’t take aspirin. These include people who:
- Have a stomach ulcer.
- Have recently had a stroke caused by bleeding in the brain.
- Are allergic to aspirin.
- Have asthma that is made worse by aspirin.
If you think you are having a stroke, do not take aspirin because not all strokes are caused by clots. Aspirin could make some strokes worse.
Gout can become worse or hard to treat for some people who take aspirin.
If you take some other blood thinner, talk with your doctor before taking aspirin, because taking both medicines can cause bleeding problems.
What Pcor Evidence Did Evidencenow Use
Here are the PCOR findings used by EvidenceNOW for aspirin use:
In 2011, the American Heart Association and the American College of Cardiology Foundation used PCOR evidence to develop guidelines on aspirin use in patients with heart disease and others who are at risk of heart attack or stroke .
Recommendation: Based on the evidence, the panel recommended long-term, low-dose aspirin therapy for patients with heart disease. For patients intolerant or allergic to aspirin, clopidogrel can be used as an alternative.
Evidence-based guidelines from the American College of Chest Physicians made the same recommendation.
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Does The Task Force Have Any Other Changes Any Other Recommendations As Far As Use Of Baby Aspirin Goes
The biggest recommendation from the task force and the draft is that if you’re an individual who does not have heart disease, who has not had a stroke, who’s not had peripheral arterial disease, that it’s really important to have your 10-year risk assessment. This is something cardiologists do and a lot of primary care providers do.
And then ask, if you’re between the age of 40 and 60 according to the draft ask a doctor whether or not aspirin is right. Based on your risk assessment, those individuals at a higher risk may still benefit from aspirin. For those individuals at a lower to moderate risk, the risk of bleeding from aspirin may outweigh the benefit for stroke and heart attack prevention.
What If I Forget To Take It
If you forget to take a dose of aspirin, take it as soon as you remember. If you don’t remember until the following day, skip the missed dose.
Do not take a double dose to make up for a forgotten dose.
If you forget doses often, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to remember to take your medicine.
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When Bleeding Risks Outweigh The Cardiovascular Benefit
According to Dr. Kirtane, the biggest concerns with aspirin are gastrointestinal bleeding and bleeding in other areas of the body, including bleeding in the brain, which can lead to a certain type of stroke. Although aspirin has a protective effect against clotting-related strokes, it can also increase the risk of bleeding-related strokes, he says.
The guidelines suggest that people in their 40s and 50s should not start aspirin to prevent heart attacks and strokes as they might have in the past. Even in higher-risk patients, like those with diabetes whose cardiovascular risk we would normally be very concerned about, it turns out that the protective effect of aspirin in preventing a first cardiac event was not so pronounced and the bleeding risk is always present, says Dr. Kirtane, who is also a professor of medicine at Columbia University Vagelos College of Physicians and Surgeons.
Around age 60, the risk of bleeding complications rises further. The new guidelines more strongly discourage starting aspirin in older patients for prevention of first cardiac events, although there may be exceptions for those with extraordinarily high cardiovascular risks, says Dr. Kirtane. At the end of the day, these decisions have to be individualized, he says.
Other Related Uspstf Recommendations
The USPSTF has made several other recommendations on CVD prevention, including statin use to prevent CVD,14 smoking cessation,15 counseling to promote a healthful diet and physical activity in persons with and without cardiovascular risk factors,16, 17 interventions to prevent obesity-related morbidity and mortality,18 as well as screening for high blood pressure19 and diabetes.20
When final, this recommendation will replace the 2016 USPSTF recommendation onaspirin use to prevent CVD and colorectal cancer .21 In 2016, the USPSTF recommended initiating low-dose aspirin use for the primary prevention of CVD and CRC in adults ages 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 ages 60 to 69 years who have a 10% or greater 10-year CVD risk should be an individual one. The USPSTF 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 age 50 years or adults age 70 years or older.
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Let’s Begin With A Reminder Of What The Current Federal Guidance Is On Using Low
The U.S. Preventive Task Force has had a recommendation for aspirin for primary prevention. That’s for prevention prior to having had a heart attack or stroke for adults. This has been the task forces recommendation, which is under review. But both the American Heart Association and the American College of Cardiology have not been making that recommendation since about 2019.
How Does Evidence Fit With Biological Understanding
Aspirinâs mechanism of action to promote CVD prevention is well known. At lower doses, aspirin is an irreversible cyclooxygenase -1 enzyme inhibitor. At higher doses, aspirin also inhibits COX-2. Aspirin reduces the risk for atherothrombosis through the inhibition of platelet function and has been used widely for the prevention of CVD events, particularly for secondary prevention.28 The COX-1 enzyme is also responsible for producing a variety of prostaglandins that protect the gastrointestinal mucosa.29 By inhibiting this enzyme, aspirin use can promote gastrointestinal bleeding.30
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Will Stopping Aspirin Lead To A Heart Attack
You might be surprised to learn that stopping daily aspirin therapy can have a rebound effect that may increase your risk of heart attack. If you have had a heart attack or a stent placed in one or more of your heart arteries, stopping daily aspirin therapy can lead to a life-threatening heart attack.
Rohan Khera Md Ms And Erica Spatz Md Mhs
Decades of research has shown the benefits of aspirin to reduce the chances of having a heart attack, stroke, or colon cancer and for many, a low-dose aspirin has been part of their daily routine. Now, new preliminary guidelines suggest that adults who may be prone to cardiovascular disease may benefit more from blood pressure management or statins. Recently, the U.S. Prevention Services Task Force , an independent panel of U.S. experts, issued draft guidelines on the primary prevention of heart attack and stroke. Currently under review, the USPSTF report could alter the 2016 recommendations by discouraging adults over the age of 60 specifically those without known cardiovascular diseasefrom a low-dose aspirin regimen.
Rohan Khera, MD, MS, an assistant professor at the Yale School of Medicine and Erica Spatz, MD, MHS, director of the Preventive Cardiovascular Health Program, associate professor at the Yale School of Medicine, and associate professor of epidemiology at the Yale School of Public Health, discuss emerging guidance on the overall benefit of aspirin therapy among older adults.
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When To Call The Doctor
Side effects can be any signs of unusual bleeding:
- Blood in the urine or stools
- Nosebleeds
- Unusually heavy menstrual bleeding or unexpected vaginal bleeding
- Vomit that looks like coffee grounds
Other side effects can be dizziness or difficulty swallowing.
Side effects include swelling in your face or hands. Call your provider if you have itching, hives, or tingling in your face or hands, very bad stomach pain, or a skin rash.
What Is The Recommended Dosage Of Aspirin In The Treatment Of Acute Coronary Syndrome And Which Form Of Aspirin Is Preferred
All patients presenting with ACS should receive nonenteric-coated chewable aspirin in a dose of at least 162 to 325 mg, unless there is a clear history of aspirin allergy. Patients with aspirin intolerance still should receive aspirin at presentation.
Chewable aspirin is preferred, as this promotes rapid absorption into the bloodstream to achieve faster therapeutic levels.
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How Does Aspirin Help Prevent Heart Attack And Stroke
Most heart attacks and strokes occur when the blood supply to a part of your heart muscle or brain is blocked. This usually starts with atherosclerosis, a process in which deposits of fatty substances, cholesterol, cellular waste products, calcium and other substances build up in the inner lining of an artery. This buildup is called plaque.
Plaque usually affects large and medium-sized arteries. Plaques can grow large enough to significantly reduce the blood’s flow through an artery. But most of the damage occurs when a plaque becomes fragile and ruptures. Plaques that rupture cause blood clots to form that can block blood flow or break off and travel to another part of the body. This is called an embolism.
- If a blood clot blocks a blood vessel that feeds the heart, it causes a heart attack.
- If a blood clot blocks a blood vessel that feeds the brain, it causes a stroke.
Aspirin thins the blood, which helps prevent blood clots from forming.
Certain patients will be prescribed aspirin combined with another antiplatelet drug also known as dual antiplatelet therapy . Learn more about DAPT.
Can Taking An Aspirin Help During A Heart Attack
Taking aspirin during a heart attack may help lessen the damage, but you should first call for emergency medical help before doing so. Since its an effective blood thinner, a small dose may be enough to stop or slow the formation of a blood clot.
With that said, aspirin isnt right for everyone. You shouldnt take it if you have an allergy to aspirin.
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Is It Heartburn Or A Heart Attack
The most common sign of a heart attack for both men and women is chest pain. But knowing whether the pain is a true warning sign of heart attack or a bout of indigestion may not always be obvious.
If your pain is similar to heartburn, but it seems worse or different than what you normally experience, you should get emergency help. This is especially important if you’re experiencing other symptoms such as shortness of breath, sweating, dizziness, nausea or pain that moves into your shoulder and arm.
Its best to pay attention when something does not feel right. Its better to visit an ER and find out its simply heartburn than to ignore the symptoms and find out too late that its serious.
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.
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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.