Updated task force guidelines do not recommend daily aspirin for heart health for most adults

“If you’re really healthy, if you’re a healthy 40-year-old male with no major risk factors, you’ll do more harm than good on daily aspirin. Your risk of bleeding will outweigh the benefits,” said Dr. Steven Nissen, chairman of cardiovascular medicine at the Cleveland Clinic, who did not participate in the new guidelines. “People need to understand that aspirin is not a completely benign or innocent therapy.”

“For secondary prevention, aspirin is important. If you have a stent, if you’ve had a heart attack or stroke, for all of those people, aspirin works. It offers a modest but definite benefit,” Nissen said.

The USPSTF is a group of independent disease prevention and medical experts from across the country who make recommendations that help guide doctors’ decisions. Their recommendations also affect insurance companies’ reimbursement decisions.

According to recommendations published Tuesday in JAMA, your doctor might consider an aspirin regimen if you’re in the age range of 40 to 59 and have a 10 percent or greater 10-year risk of cardiovascular disease.

This means your risk 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 level, blood pressure, medication use, diabetes status and smoking status. According to the task force, a daily aspirin “has only a small net benefit,” for this particular group.

Studies have led to a shift in focus

The basis for the updated recommendations is the task force’s review of several large randomized clinical trials of low-dose aspirin use, which found an association with a lower risk of myocardial infarction and heart attack. stroke, but not a reduction in mortality. Low-dose aspirin was also associated with an increased risk of bleeding.

When the task force last updated these recommendations, in 2016, it suggested that daily aspirin might be beneficial in preventing colorectal cancer. But the updated guidelines say there is limited evidence that it reduces the risk of colorectal cancer or death from it.

The 2016 guidelines indicated that there was some merit in daily aspirin use for people aged 50 to 59 who had a 10-year risk of cardiovascular problems greater than 10%, who were expected to live more than 10 years and who were not at higher risk of bleeding. .

The 2016 guidelines also suggested that people aged 60 to 69 with a cardiovascular risk of 10% or more should make an individual decision about taking a daily aspirin.

Bleeding problems in people without high-risk conditions like peptic ulcer disease, NSAID use, or corticosteroid use are rare, the task force notes, but the risk increases with age. “The modeling data suggests that it may be reasonable to consider stopping aspirin use around age 75.”

Previous Cardiac Guidelines Changes

These are not the only recommendations for the daily use of aspirin. The new USPSTF guidelines are now more in line with the American College of Cardiology/American Heart Association guidelines and recommendations for the average person who has never had a cardiac event, according to Dr. Roger Blumenthal, who co-chaired the committee that created the ACC/AHA guidelines.

“When you look at all the studies that have been done recently, it seems that the modest benefit of aspirin and other low-risk people is generally outweighed by the increase in long-term gastrointestinal problems, bleeding with aspirin,” Blumenthal said. “Although we said it could be considered giving aspirin to someone who has never had a heart attack or stroke, that should probably be the last thing on the list of things to do. priorities.”

“Aspirin may still make sense in certain situations, where we’re not doing as good a job of controlling cholesterol, blood pressure, for whatever reason,” Lloyd-Jones said. “Maybe the drugs are too expensive or a health system in a country can’t dispense those things, aspirin might still make sense, but I think in a lot of situations in that country, where if people have good access to health care and are taking care of other risk factors, aspirin now makes much less sense.”

“We always preach that DNA is not your destiny, which means there are so many things we can do from a lifestyle perspective that can reduce chronic disease and your risk of heart disease. and stroke,” Buchinsky said.

He suggests a good diet with “real food” 90% of the time and 10% “fun food”. Aim for at least 150 minutes of physical activity per week, get enough sleep and target stress. Do not smoke and drink to a minimum. Medicines for cholesterol, diabetes and high blood pressure can also help if needed, but he said it’s even better if a patient doesn’t need them.

“Prevention is much easier than cure,” Buchinsky said.