Should You Avoid Your Daily Aspirin Regimen? Here's What To Know

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Fact CheckedShould You Avoid Your Daily Aspirin Regimen? Here’s What to Know

Written by George Citroner on October 13, 2021 — Fact checked by Dana K. Cassell

Based on new evidence, the U.S. Preventive Services Task Force says daily low-dose aspirin in people 60 years old or older has no net benefit due to an increased risk of bleeding.
Evidence now suggests the “net benefit” of aspirin use for people 40 to 59 years old who have a 10 percent or more 10-year cardiovascular disease (CVD) risk is small.
Experts say some groups including people with heart disease or who had a stent, angioplasty and coronary artery bypass surgery, could benefit from aspirin.

The U.S. Preventive Services Task Force (USPSTF) released new draft recommendations on Oct. 12 that no longer advise using aspirin to prevent heart attack and stroke for some groups.

Many people take a daily low-dose pill to help prevent heart attack or stroke. But new evidence has found that taking a daily aspirin can raise the risk of certain complications.

The new guidelines

According to USPSTF, evidence now suggests the “net benefit” of aspirin use for people 40 to 59 years old who have a 10 percent or more 10-year cardiovascular disease (CVD) risk is small.

The task force also concluded that starting aspirin use to prevent CVD events in adults age 60 years or older has no benefit at all.

Some groups are still advised to take daily aspirin.

“These recommendations do not apply to people who have had a heart attack or stroke, or have a stent in an artery,” Dr. Donald M. Lloyd-Jones, volunteer president for the American Heart Association (AHA), said in a statement.

“Those patients should remain on aspirin as prescribed by their doctor,” he continued. “But in adults without known cardiovascular disease, we continue to urge clinicians to be very selective when prescribing aspirin.”

Not recommended for people with increased bleeding risk

“Bleeding is a major concern in patients 60 and older who are at risk for heart disease if they are newly placed on a daily baby aspirin regimen,” Dr. Robert Glatter, an emergency physician at Lenox Hill Hospital in New York, told Healthline.

Glatter noted that a significant concern for older patients on long-term baby aspirin regimens is the risk of bleeding in the brain from head trauma experienced in falls.

Aspirin still useful

Dr. Guy L. Mintz, director of cardiovascular health and lipidology at the Sandra Bass Heart Hospital in Manhasset, New York, said, “Aspirin definitely has a role to play.”

He explained that patients with heart disease, stent, angioplasty, coronary artery bypass surgery, stroke, peripheral arterial disease, and transient ischemic attacks (“ministroke”) could benefit from aspirin.

He also cautioned that patients on an aspirin regimen should talk with their doctor first before stopping.

“Aspirin also had an anti-inflammatory effect reducing c-reactive protein, a marker of inflammation,” said Mintz. “The Physician’s Health Study from 1988 showed aspirin reduced heart attacks.”

New therapies available without aspirin’s risks

Although the USPSTF concluded that using aspirin for patients without heart disease was associated with potentially dangerous bleeding, Mintz said there are other ways to reduce risk.

“Today, we have highly effective therapies that significantly reduce the chance of a heart attack,” he said.

Mintz said this includes:

potent cholesterol lowering medications

new diabetic medications reduce cardiac death, reduce heart failure, improve kidney function and blood sugar

effective medications to reduce blood pressure and blood pressure targets lower than previous guidelines

“We have [also] recognized obesity and insulin resistance as inflammatory states which contribute to cardiovascular disease, and [have] effective therapy for these states as well,” he added.

Determine your cardiac risk profile

According to Mintz, major cardiac risk factors include a family history of heart disease, diabetes, high cholesterol, hypertension, smoking, and obesity.

Patients should talk with their doctor to review their cardiovascular risk, he said.

Mintz advised that people with cardiac risk factors have their cardiac risk profile measured.

“Each patient without heart disease between ages 40 to 70 years should have their 10-year cardiovascular risk measured using the ACC/AHA cardiac risk calculator, which provides the 10-year cardiac risk and helps identify a treatment pathway,” Mintz said.

The bottom line

Based on new evidence, the USPSTF says daily low-dose aspirin in people 60 years old or older has no net benefit due to an increased risk of bleeding.

The task force also said people 40 to 59 years old with a 10 percent or greater risk of experiencing a first cardiovascular event within 10 years experience only a small net benefit and should consult a doctor before taking aspirin daily. Experts say these guidelines refer only to aspirin and not other blood-thinning drugs, and no one currently using aspirin should stop before speaking with a healthcare professional.

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Written by George Citroner on October 13, 2021 — Fact checked by Dana K. Cassell

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