Intermountain Healthcare

Should you take a daily Aspirin if you’ve never had a heart attack?

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(ABC4 Utah) After years of recommending that middle-aged and older Americans consider taking low-dose aspirin to prevent a first heart attack or stroke, the US Preventative Services Task Force is planning to overhaul its guidelines, based on new studies that show that the risks may greatly reduce or cancel out the benefits.

The message from heart doctors: if you don’t have a history of heart attack and stroke, you shouldn’t be starting on aspirin just because you reach a certain age.

Previous guidelines encouraged middle age and older adults to take a low-dose aspirin every day to help prevent a heart attack or stroke. For decades doctors said taking a daily 80 to 100 milligrams of aspirin could prevent cardiovascular problems for people who had never been diagnosed with heart disease.

That advice is changing.  

“It should be emphasized that these guideline changes only refer to people who, as of yet, have NO evidence of heart disease,” emphasized Dr. Brent Muhlestein, a research cardiologist from the Intermountain Healthcare Heart Institute. “Among patients with known heart disease, especially those with atherosclerotic cardiovascular disease, aspirin is still known to be very beneficial, and in many instances, life-saving.  There are no new changes in existing guidelines regarding the use of aspirin among patients with KNOWN heart disease.”

The new draft recommendations DO NOT apply to people who have had a heart attack or stroke in the past and are now taking daily aspirin. People without a history of heart attack or stroke who are already taking preventive doses should not stop without consulting with their doctor.

The task force is an independent panel composed of experts in disease prevention and evidence-based medicine whose recommendations can influence medical practices regarding preventive health measures.

This recommended change comes after a large clinical trial found daily low-dose aspirin had no effect on prolonging life in healthy, elderly people – and that even at low dosages, long-term use of aspirin might be damaging– without providing any advantage– for older individuals who have not currently had a heart attack or stroke.

The new recommendations said low-dose aspirin should not be given on a routine basis to prevent atherosclerotic cardiovascular disease in adults older than 70 or any adult with an increased risk of bleeding.

Heart doctors agree that for older adults with low risk– no prior history of heart attack or stroke– the risk of intestinal bleeding outweighs any heart advantage.

Experts say clinicians need to be very selective in recommending aspirin for people without known heart disease. Aspirin needs to be limited to individuals at the highest danger of heart disease and a very low danger of bleeding.

Taking aspirin regularly can increase the risk of bleeding in the intestinal tract, especially for vulnerable people, like those with ulcers. Reflecting the latest data, the new guidelines recommend aspirin only after other heart disease risk factors — including cholesterol, blood pressure, diabetes, smoking, weight and exercise — have been addressed.

The change in recommendations could affect millions of people nationwide. Heart disease is the leading cause of death in the United States, killing roughly 659,000 people each year.  Strokes rank fifth, with about 150,000 fatalities yearly. 

According to the task force’s draft recommendation, a review of the latest scientific evidence found that regularly taking low-dose aspirin — 81 milligrams to 100 milligrams — to prevent a first heart attack or stroke may have only a “small net benefit” for people ages 40 to 59 who are at risk for cardiovascular disease. The task force emphasized that patients should make decisions about taking aspirin only in consultation with their health-care provider.

Almost 80 percent of all heart disease can be prevented with lifestyle modifications, according to the AHA. Doctors recommend routine exercise and following plant-based diet plans such as DASH, a meal strategy that stresses fruits, veggies and whole grains to lower heart disease risk.

Visit the Intermountain Healthcare website for more information.

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