The surprising new recommendations from an influential health guidelines group on daily low-dose aspirin regimens reflect the latest science and “make a tremendous amount of sense,” according to a Boston Medical Center expert.
“I think we’re in a really important and interesting time in science, where we’re continuing to let the data guide us to improve the health of populations,” Dr. Katherine Gergen Barnett, vice chair of family medicine at the hospital, said, noting that the public had seen with the COVID-19 pandemic how science evolves rather than staying static.
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 Preventive 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 task force had also previously seen aspirin as offering benefits in preventing colorectal cancer, but in the new guidance said the latest evidence was unclear, and called for more research.
Dr. John Wong, a primary-care expert at Tufts Medical Center who is a panel member, said, “Aspirin use can cause serious harms, and risk increases with age.” He said that, in addition to newer studies, a reanalysis of older studies prompted changes to the guidance.
Oct. 12, 2021 – People 60 years old and older should not start taking daily aspirin to prevent cardiovascular disease, according to draft recommendations from a national task force that monitors best ways to prevent disease.
The U.S. Preventive Services Task force’s proposed guidance says daily aspirin “has no net benefit” for cardiovascular health.
The task force also says people age 40 to 59 with higher risk of disease should make individual decisions about whether to take aspirin.
“Persons who are not at increased risk for bleeding and are willing to take low-dose aspirin daily are more likely to benefit,” the task force said.
The new recommendations were posted online today and will be available for public comment until Nov. 8. Once finalized, the recommendation will become the first new recommendations on aspirin to prevent cardiovascular disease and colon cancer since 2016..
Any time anyone is concerned about their stroke or heart attack risk, we would encourage them to speak with their clinician, who can then help them assess what their individual risk is for a stroke or heart attack, as well as whether or not aspirin is appropriate for them.
But, when we look at the evidence, the risk for people in their 60s and older, cancels out or balances out the benefits, so that we would not end up recommending it. For people who are younger, we used to recommend starting aspiring. But we now recommend that they speak with their clinician about aspirin, because the balance of benefits and harms is now closer.
The updated guidance recommends that adults in their 40s and 50s only take aspirin as a preventive measure if their doctors determine they are at higher risk for heart disease and that aspirin may lower the risk without significant risk of bleeding. (The previous guidance didn’t address anyone younger than 50.) People ages 60 or older are now advised not to start taking aspirin to prevent first heart attacks or strokes.
The draft recommendations don’t apply to people who have already had heart attacks or strokes; the task force still recommends that they take aspirin preventively.
“For anyone who is on aspirin because they’ve already had a heart attack or stroke, it’s a very important medication,” said Dr. Erin Michos, an associate director of preventive cardiology at the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, who isn’t part of the task force.
Heart disease is the leading cause of death in the U.S., and according to the most recent data available, 29 million adults in the U.S. take aspirin daily to prevent heart disease even though they don’t have histories of it.
Aspirin acts as an anticoagulant, meaning it helps to prevent blood clots from forming. A clot that cuts off blood flow to the heart leads to a heart attack; one that cuts off blood flow to the brain causes a stroke. The idea behind taking a daily low-dose aspirin was to lower the risk of such clots, lowering the risk of heart attack or stroke.
But the same mechanism that lets aspirin prevent blood clots from forming can also increase a person’s risk of bleeding, because it prevents blood from clotting at the site of a wound.
Newer studies that informed the latest task force recommendations found that for most healthy people, the risk of bleeding caused by aspirin outweighs the benefits of preventing blood clots. For the same reason, the American Heart Association and the American College of Cardiology jointly issued similar recommendations in 2019, stating that people ages 70 and older shouldn’t take daily aspirin to prevent heart attacks or strokes because the risk of gastrointestinal bleeding was high in relation to the benefit of aspirin.
Daily aspirin use may help
prevent heart attacks and strokes in some people, but it can also cause potentially serious harms, such as internal bleeding,” Task Force member Dr. John Wong said in a statement. “It’s important that people who are 40 to 59 years old and don’t have a history of heart disease have a conversation with their clinician to decide together if starting to take aspirin is right for them.
“The last time the task force made a recommendation on the use of a daily aspirin was in 2016 when it said the decision to start taking low-dose aspirin “should be an individual one” for adults 60 to 69. At the time, the task force recommended a daily low-dose aspirin for adults ages 50 to 59 who have a 10% or greater risk of cardiovascular disease and no increased for bleeding.The new draft recommendation updates the task force’s 2016 final recommendation on aspirin use to prevent cardiovascular disease and colorectal cancer — but the new draft focuses only on the prevention of cardiovascular disease and calls for more research around taking aspirin to prevent colorectal cancer.