Ep. 32: New Recommendations for Daily Aspirin

In today’s episode, Dr. Brian Cole takes a look at how aspirin has been used over the years — and where the medical advice stands today.

Are you one of the millions of people who take an aspirin a day? For many years, physicians have recommended that those at risk for stroke or cardiovascular disease take a daily, low-dose aspirin to prevent heart attack or stroke. However, this week the U.S. Preventative Services Task Force (USPSTF) drafted new recommendations indicating this practice should be curtailed. The proposed recommendation is based on mounting evidence that the risk of serious side effects far outweighs the potential benefit.

Task Force Pulls Back on Recommendation

Aspirin inhibits the formation of blood clots that can block arteries, prompting the task force to endorse the aspirin-a-day recommendation in 2016, but a review of the latest scientific evidence has raised concerns that regular intake increases the risk of bleeding, especially in the digestive tract and the brain, dangers that increase with age. While a daily, low dose aspirin (81 to 100 mg) may help prevent heart attacks and strokes in some people, it can also cause potentially serious harm, such as internal bleeding. The task force believes the higher risk of bleeding with age actually cancels out the potential benefit of taking a daily aspirin. For this reason, the task force is pulling back on the blanket statement that everyone who is at increased risk for heart disease, even though they never had a heart attack, should be on aspirin.


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Consider Age and Risk Factors

The newly drafted Task Force recommends suggest that individuals aged 60 and older should not take aspirin for heart disease and stroke prevention, while those between 40 and 59 years old who have some risk for cardiovascular disease but no history should discuss the aspirin option with their doctor. In their statement, the task force noted that when deciding whether patients should start taking aspirin to prevent a first heart attack or stroke, clinicians should take into consideration age, heart disease risk and bleeding risk. It is important to note that the task force recommendation is not for people already taking aspirin for a previous heart attack or stroke; they should continue to do so unless told otherwise by their clinician.

If finalized, the draft recommendations on cardiovascular disease would bring the USPSTF guidelines more closely in line with those of the American College of Cardiology (ACC) and the American Heart Association (AHA), which were updated in 2019. The new guidelines, which are not yet final, have the potential to affect tens of millions of adults who are at high risk for cardiovascular disease, which continues to be the leading cause of death in the United States.


Authored by Zach Meeker, Research Assistant for Midwest Orthopaedics at Rush University Medical Center

Reference:

U.S. Preventive Services Task Force (October 12, 2021). Draft Recommendation Statement: Aspirin Use to Prevent Cardiovascular Disease: Preventive Medication.