Multiple, extensive studies have prompted doctors to rethink their openness to recommending low-dose aspirin every day as a way of preventing heart attacks and strokes in people who don’t have a history of cardiovascular diseases.
The national conversation surrounding aspirin began last year when a large clinical trial in Australia found that a daily low-dose aspirin had no effect on prolonging life in healthy, elderly people. Not only was there no benefit for the participants, who were 70 or older, but results also showed that they were at a higher risk of bleeding, such as hemorrhages.
An increased risk of bleeding in the skull was also found in a more recent study published in May, which focused on participants who had no history of heart attacks or strokes.
The American College of Cardiology and the American Heart Association published updated guidelines in March that reversed the recommendation of a low-dose, daily aspirin to prevent heart attacks and strokes for people who don’t have a history of cardiovascular disease.
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This week, a new study is asking the millions of people who take aspirin every day to prevent heart attacks to have serious conversations with their doctors about whether they truly need it.
The guidelines focused on two specific points:
- People over 70 who don’t have heart disease — or are younger but at increased risk of bleeding — should avoid daily aspirin for prevention.
- Only certain 40- to 70-year-olds who don’t already have heart disease are at high enough risk to warrant 75 to 100 milligrams of aspirin daily, and that’s for a doctor to decide.
Two doctors spoke to USA TODAY about what the new studies and guidelines mean for millions of Americans.
But patients should speak with their primary care providers before discontinuing daily aspirin use or starting it.
The following explanations also apply only to long-term aspirin use — not to patients taking on an as-needed basis for aches and pains.
Aspirin is a key aspect of treatment for many patients who have a history of cardiovascular disease or heart problems, such as experiencing a heart attack, said Dr. Dan Muñoz, assistant professor of medicine at Vanderbilt University.
These patients are categorized into secondary prevention, which means that they have already had cardiovascular issues in the past and are preventing a second occurrence with daily, low-dose aspirin.
“As doctors we care for patients across the spectrum, we want to make sure the right message reaches the right patients,” Dr. Muñoz said. That message: Patients with cardiovascular disease already taking aspirin as recommended by their doctor should continue to do so.
The guidelines outlined in March focus on primary prevention, which is preventing a heart attack or stroke in patients who have never had one.
With some specific exceptions, people who have never had a heart attack, or any other cardiovascular disease, should not be taking low-dose aspirin every day.
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Multiple studies have seriously criticized aspirin’s benefit as treatment to heart attacks and strokes, saying it does not translate to primary prevention.
Dr. Eugene Yang, professor of medicine at Washington University, says the risk of internal bleeding is not worth the lack of benefits.
And Dr. Muñoz agrees.
“Aspirin’s strength is also its weakness,” said Dr. Muñoz. “It prevents the blood clots that could cause heart attacks and strokes, but by preventing those blood clots it opens itself to bleeding.”
What doctors recommend
There are many conditions that may call for a daily, low-dose of aspirin that fall in between the guidelines.
Doctors recommend that patients speak with their primary care providers before taking independent action, whether it’s discontinuing daily aspirin use or starting it.
As Dr. Yang and Dr. Muñoz said, patients that take routine low-doses as a method of secondary prevention should not stop taking it. Doing so, they explain, would pose a risk to patients who have a history of cardiovascular diseases.
Even if patients don’t have a history of heart disease, it’s important to consult a doctor because there may be other reasons for taking it.
For example, studies have shown that aspirin has been linked to a reduced risk of cancer, according to the National Cancer Institute.
Aspirin, just like acetaminophen and ibuprofen, is fine for short-term use for aches and pains, Dr. Yang said. It’s the long-term use that’s worth a conversation with a physician.