People over 60 shouldn’t take daily aspirin to prevent a first stroke or heart attack, according to a U.S. review panel.
According to draft recommendations issued by the U.S. Preventative Services Task Force on Tuesday, the risks of taking daily aspirin, also known as acetylsalicylic acid or ASA, outweigh the potential benefits in people over 60.
These risks include internal bleeding in the stomach, intestines and brain, according to the panel.
Guidelines in Canada are even more strict — recommending that no one take daily aspirin to prevent heart attack or stroke if they have no history of cardiovascular conditions.
“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,” said Task Force member Dr. John Wong, in a press release.
However, slightly younger adults aged 40 to 59 who are at high risk of cardiovascular disease should discuss with their physicians whether or not to take preventative aspirin, the panel said, as it may still have benefits for younger people.
Clinicians should consider age, cardiovascular disease risk and bleeding risk when determining whether or not to prescribe a patient aspirin, the panel said. It does not change the recommendations for people who have already had a heart attack or stroke who are taking aspirin on the advice of their doctor.
“The latest evidence is clear: starting a daily aspirin regimen in people who are 60 or older to prevent a first heart attack or stroke is not recommended,” said Task Force member Dr. Chien-Wen Tseng.
“However, this 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.”
The guidance was posted online to allow for public comments until Nov. 8. The group will evaluate that input and then make a final decision.
Canadian guidelines published by Heart and Stroke in 2020 recommended against taking aspirin to prevent stroke, heart attacks and vascular disease for people who don’t have a history of these conditions. The organization cited the risk of internal bleeding as the reason for changing its guidance.
“I remember when I was a kid, my mom used to tell me an aspirin a day keeps the doctor away, and I think things have changed very much,” said Dr. Ted Wein, a stroke neurologist at McGill University and former chair of the Canadian Stroke Prevention Guidelines, who helped write Canada’s guidelines on aspirin.
Large studies in 2018 and 2019 showed that few people benefitted from taking aspirin to prevent heart attacks if they had no history of cardiovascular disease, he said. Dr. Wein added that researchers noticed an increase in “potentially harmful” bleeding in the stomach or brain, which he said led Heart and Stroke, a charity dedicated to heart and stroke research in Canada, to revise its guidelines.
“Our guidelines suggest that for the majority of people, that aspirin not be used in primary prevention. So if you’ve never had a heart attack, stroke or any peripheral vascular disease, we suggested that it not be prescribed to the majority of individuals,” he said.
Dr. Wein stressed, however, that people who have experienced cardiovascular events should continue to take aspirin, especially if it has been prescribed to them. If you’re thinking about taking aspirin to prevent stroke or heart attack, or if you’re unsure if you should keep taking it, you should speak to your doctor, he said.
In a press release in March 2020, Heart and Stroke estimated that around 5.3 million Canadian adults were taking aspirin to prevent heart disease and stroke, with about 2.4 million people doing it without guidance from a doctor.
Quitting smoking, cutting back on drinking, getting regular exercise and eating a healthy diet are all much more effective ways to reduce your risk of heart attack and stroke than aspirin, Dr. Wein said.
Dr. Lauren Block, an internist-researcher at Feinstein Institutes for Medical Research in Manhasset, N.Y., said the guidance is important because so many adults take aspirin even though they have never had a heart attack or stroke.
Dr. Block, who is not on the task force, recently switched one of her patients from aspirin to a cholesterol-lowering statin drug because of the potential harm.
The patient, 70-year-old Richard Schrafel, has high blood pressure and knows about his heart attack risks. Mr. Schrafel, president of a paperboard distribution business, said he never had any ill effects from aspirin, but he is taking the new guidance seriously.
Rita Seefeldt, 63, also has high blood pressure and took a daily aspirin for about a decade until her doctor told her two years ago to stop.
“He said they changed their minds on that,” recalled the retired elementary school teacher from Milwaukee.
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