Low-Dose Aspirin May Do More Harm Than Good

The new recommendations on the use of aspirin in low doses to prevent a first heart attack or stroke, they argue that the anticoagulant’s risks may outweigh its benefits, breaking with more than 30 years of widely accepted medical guidelines.

Current evidence highlighting the risks of internal bleeding associated with aspirin use prompted the US Preventive Services Task Force to revise its 2016 guidelines. The final recommendations, based on analysis of randomized clinical trials in the thousands of people participated, were published on Tuesday.

Heart disease is the leading cause of death in the United States, accounting for one in four deaths, according to the Centers for Disease Control and Prevention (CDC).

Easily available without a prescription, aspirin has long been considered an affordable prevention strategy for those concerned about their heart health, as it reduces blood clotting. Untreated blood clots can lead to a heart attack or stroke.

People older than 60 who are not already taking aspirin as a blood thinner should not start taking it as a preventative measure against heart attack or stroke, according to updated guidelines.

People ages 40 to 59 who are concerned about cardiovascular disease should only use low-dose aspirin in consultation with a health care professional who can help assess individual benefits and risks.

“This is an important recommendation as more than 600,000 people will have a first heart attack this year and another 600,000 will have their first stroke,” said John Wong, a professor at Tufts University School of Medicine and a member of the task force. .

The task force’s updated guidelines are a significant change from 2016, when low-dose aspirin was recommended for most people in their 50s and 60s who were not at high risk of bleeding and individualized to people over 60 years of age.

Anticoagulant properties

Aspirin’s blood-thinning properties pose a risk to people with other health problems that may predispose them to bleeding. For these people, the task force reviewed the evidence from 14 randomized clinical trials and found that aspirin was associated with an increased risk of gastrointestinal and intracranial bleeding.

The risk of internal bleeding, with or without aspirin, increases with age. The task force review notes that bleeding risks are also higher in men, people with diabetes and those with a history of gastrointestinal problems.

Liver disease, smoking, and high blood pressure also increase risk. Some medications, such as nonsteroidal anti-inflammatory drugs, steroids, and other blood thinners, are also risk factors.

For people ages 40 to 59, who are not at risk of bleeding and are worried about having a heart attack or stroke, there may be some net benefit from taking low-dose aspirin for prevention, according to the review. But, before starting the medication, people should first talk to a doctor.

Other preventive health measures, such as regular exercise and healthy eating habits, are very effective in improving heart and general health. Wong said quitting smoking, treating high blood pressure and managing blood pressure are also important tools to help prevent a heart attack or stroke.

People already taking aspirin, or those who have already had a heart attack or stroke, should make all decisions in coordination with a health care professional, Wong said.