Is Aspirin Still The Best Thing For Heart Attacks?
People who are 60 and over should not take daily low-dose aspirin to prevent a first heart attack or stroke, a health guidelines panel said in a draft recommendation recently.
The U.S. Preventative Services Task Force (Task Force), a national panel of experts in prevention and evidence-based medicine, also recommended that people 40 to 59 who are at a higher risk for heart disease and stroke and do not have a history of cardiovascular disease should decide with their doctor whether using daily low-dose aspirin is right for them.
“Daily aspirin use may help prevent heart attacks and strokes in some people, but it can also cause potentially serious harm, such as internal bleeding,” said Dr. John Wong, a Task Force member and a primary care physician at Tufts Medical Center.
Aspirin is mostly known as a pain reliever but it is also known to increase the risk of major bleeding in the stomach, intestines, and brain. What’s more, the chances of bleeding episodes increase with age and can be life-threatening.
Dr. Chien-Wen Tseng, another Task Force member, said the recommendation is not for people already taking aspirin for a previous heart attack or stroke. These people should continue to take aspirin unless told otherwise by their doctor, said Tseng, a physician at Pali Momi Medical Center in Hawaii who specializes in family medicine.
The Task Force’s most recent guidance is a shift from 2016 when the panel recommended low-dose aspirin for people in their 50s with a 10 percent or greater risk of heart disease over the next 10 years. The panel also recommended that adults 60 to 69 years old with a 10 percent or greater 10-year cardiovascular risk should decide on their own about taking low-dose aspirin for primary prevention.
Panel members say the most recent recommendation is based on new evidence that emerged since 2016. It is now recommended that people 60 and older should not consider starting to take aspirin because the risk of bleeding cancels out the benefits of preventing heart disease.
Medical experts say the Task Force’s recommendation is similar to previous guidelines published by the American College of Cardiology (ACC) and the American Heart Association (AHA). In 2019, the ACC and AHA jointly recommended aspirin for primary prevention of heart disease for people 40 to 70 years old who are not at increased risk for bleeding. However, daily low-dose aspirin should not be used in those older than 70.
Heart disease and stroke are leading causes of death in the United States, according to the U.S. Centers for Disease Control and Prevention (CDC). Statistics from the public health agency show about 795,000 Americans have a stroke each year. The U.S. Department of Health and Human Services, Million Hearts Initiative says that more than 800,000 people die from cardiovascular disease each year—that’s 1 in every 3 deaths, and about 160,000 of them occur in people under age 65.
Task Force Draft Recommendation Based on Latest Research
Prior to announcing the latest recommendation, the Task Force conducted a review of 23 studies, published between January 2014 and January 14, 2021. The studies involved the effectiveness of aspirin to reduce the risk of cardiovascular disease, death by cardiovascular disease, and all causes of death in people who do not have a history of cardiovascular disease.
Many medical experts have already pointed to various studies that have found the risks of using low-dose aspirin to prevent stroke and heart disease outweigh the benefits.
One study, the Aspirin in Reducing Events in the Elderly (ASPREE) trial, reported that daily use of low-dose aspirin did not benefit people who were 70 and older.
According to Dr. Steven Nissen, the ASPREE trial showed aspirin posed an increased risk of gastrointestinal or brain bleeding which offset any benefit from reduced risk of cardiovascular events. But aspirin should not be completely discounted, said Nissen, Chief Academic Officer of Cleveland Clinic’s Miller Family Heart, Vascular & Thoracic Institute.
Nissen also said the Task Force “has been out of step with other organizations” when it comes to low-dose aspirin but now they are “coming into alignment with what almost everyone else has been saying.
What should “not get lost in this discussion,” Nissen said is that low-dose aspirin is widely recommended to use in secondary prevention of cardiovascular disease. At the same time, Nissen added, doctors should be careful to avoid recommending aspirin in people with an increased risk of bleeding.
The U.S. Food and Drug Administration (FDA) has also reviewed studies regarding low-dose aspirin’s prevention of cardiovascular disease. In 2014, the FDA issued a statement saying that the agency did not believe that “the evidence supports the general use of aspirin for primary prevention of a heart attack or stroke.”
Other Heart Disease Treatment Available Besides Aspirin
Besides reviewing studies, health experts believe the Task Force also considered the advances in cardiovascular disease prevention that do not have the potential to cause serious harm like aspirin.
For example, there are better medications for cholesterol, hypertension, and diabetes, said Dr. Guy L. Mintz, Northwell Health’s director of cardiovascular health and lipidology at Sandra Atlas Bass Heart Hospital. In addition, Mintz said there are also tools to identify and treat other problems that affect heart health, such as insulin resistance and sleep apnea.
The advances have negated the need for all patients to use aspirin, Mintz said. However, patients should not stop taking aspirin without consulting their doctor because some patients can still benefit from using aspirin, he said.
Prior to the Task Force’s announcement, Dr. Lauren Block, an internist-researcher at Feinstein Institutes for Medical Research in Manhasset, New York, said she had recently switched a patient from using aspirin to a cholesterol-lowering statin because of aspirin’s potential harm. Block said the panel’s guidance is important because of the number of people taking aspirin to prevent cardiovascular disease.
Rita Seefeldt, a Milwaukee, Wisconsin, resident with high blood pressure, said her doctor told her two years ago to stop using aspirin, which she had been taking every day for about a decade. She said she understands that science evolves.
The Task Force posted the draft recommendation statement online and asked for comments by November 8 on the draft statement, the draft evidence, and the draft modeling report. The Task Force will prepare a final recommendation after considering the comments.