(CNN) — After years of recommending taking aspirin regularly to prevent heart attacks and strokes, scientists now see little benefit for most healthy people, saying it may contribute to an increased risk of bleeding in the stomach or brain. as people age.
The US Preventive Service Task Force (USPSTF) has finalized its latest recommendations on low-dose aspirin regimens and now says that people over the age of 60 should not start taking a daily aspirin for primary prevention of heart problems in most cases.
If you are between the ages of 40 and 59, the USPSTF leaves it up to you and your doctor to decide whether you should take a daily aspirin under certain circumstances.
“If you’re really healthy, if you’re a healthy 40-year-old with no major risk factors, daily aspirin will do more harm than good. The risk of bleeding will outweigh the benefits,” said Dr. Steven Nissen, chair of cardiovascular medicine at the Cleveland Clinic, which was not involved in the new guidelines. “People have to understand that aspirin is not a completely benign or innocent therapy.”
But if you’ve had a heart attack, stroke, or other heart or circulation problems and your doctor has prescribed you a daily aspirin, don’t stop taking it. Instead, talk to him about what these new recommendations mean to you.
“In secondary prevention, aspirin is important. If you have a stent, if you’ve had a heart attack or a stroke, for all those people aspirin works. It provides a modest but definite benefit,” Nissen said.
The USPSTF is an independent group of medical and disease prevention experts from around the country who make recommendations that help guide physician decisions. Their recommendations also affect the reimbursement decisions of insurance companies.
How does aspirin work?
Aspirin works by stopping the body from producing certain natural substances that cause pain and inflammation. It can also prevent blood from clotting, which is why doctors have recommended it for years to prevent cardiovascular problems like heart attacks and strokes.
According to the recommendations, published Tuesday in JAMA, your doctor may want to consider an aspirin regimen if you’re in the age range 40 to 59 and have a 10% or greater risk of developing cardiovascular disease in 10 years.
This would mean that your chance of having a heart attack or stroke in the next 10 years is higher than normal, based on a calculation that includes factors such as age, gender, race, cholesterol levels, blood pressure blood pressure, medication use, diabetic status, and smoking. According to the task force, a daily aspirin only “has a small net benefit” specifically for this group.
Studies prompted change in guidance on aspirin
The basis for the updated recommendations is the task force’s review of several significant randomized clinical trials of low-dose aspirin use, which found an association with a reduced risk of heart attack and stroke, but not a mortality reduction. Low-dose aspirin was also associated with an increased risk of bleeding.
The last time the task force updated these recommendations, in 2016, it suggested that daily aspirin might be beneficial for colorectal cancer prevention. But the updated guidelines say there is limited evidence that it reduces colorectal cancer risk or death from colorectal cancer.
The 2016 guidelines that there was some merit in the use of daily aspirin for people aged 50 to 59 years who had a 10-year risk of cardiovascular problems greater than 10%, who were expected to live more than 10 years and who did not had a higher risk of bleeding.
The 2016 guidelines also suggested that people aged 60 to 69 with a cardiovascular risk of 10% or greater should make an individual decision about daily aspirin use.
Bleeding problems in people without high-risk conditions such as peptic ulcer disease, nonsteroidal anti-inflammatory drug use, or corticosteroids are rare, the task force notes, but the risk increases with age. “The modeling data suggest that it may be reasonable to consider stopping aspirin around age 75.”
Cardiovascular disease is the leading cause of death in the United States, responsible for more than one in four deaths, according to the Centers for Disease Control and Prevention.
“The more data we get, the more we see that while the risk of coronary heart disease and heart attack increases with age, the risk of bleeding appears to increase even faster,” said Dr. James Cireddu, medical director of the Cardiovascular Institute. Harrington of University Hospitals Medical Center in Bedford, who did not work on the orientations.
Other Heart Health Updates
These are not the only recommendations about daily aspirin consumption. The new USPSTF guidelines are now more in line with the American College of Cardiology/American Heart Association guidelines and their recommendations for the average person who has never had a cardiac event, according to Roger Blumenthal, MD, who co-chaired the committee behind of the guidelines of these institutions.
“When you look at all the studies that have been done recently, it seems that the modest benefit of aspirin in low-risk individuals is generally offset by the increase in long-term gastrointestinal problems, (ie) bleeding with aspirin” Blumenthal said. “While we said giving aspirin to someone who has never had a heart attack or stroke might be considered, it should probably be the last thing on the priority list.”
Aspirin may still have a place in heart health, said Dr. Donald Lloyd-Jones, president of the American Heart Association.
“Aspirin might still make sense in some situations where we’re not doing a good job of controlling cholesterol or blood pressure for whatever reason,” Lloyd-Jones said. “Maybe (in cases where) drugs are too expensive or the health system in a country can’t distribute those things, aspirin might still make sense, but I think in a lot of situations in this country, if people have a good access to health care and they’re taking care of the other risk factors, aspirin now makes a lot less sense.
Other measures to help your heart health
Other steps can be taken to help heart health with little, said Dr. Roy Buchinsky, director of wellness at Ohio University Hospitals, who was not involved in the new USPSTF guidelines.
“We always preach that DNA is not your destiny, which means there are many things we can do from a lifestyle standpoint that can reduce chronic disease and the risk of heart disease and stroke,” Buchinsky said.
The doctor suggests a good diet with “real food” 90% of the time and “fun food” 10%. Try to get at least 150 minutes of physical activity a week, get plenty of sleep, and manage stress. Don’t smoke and keep alcohol consumption to a minimum. Cholesterol, diabetes and high blood pressure medications can also help if needed, but he said it’s even better if the patient doesn’t need them.
“Prevention is much easier than cure,” Buchinsky said.