The statement, published Tuesday in JAMA, is based on evidence that has accumulated over the last few years that shows the risk of potentially fatal internal bleeding that can result from regular aspirin use may be greater than the preventive benefits. “This update will bring the USPSTF recommendations more in line with the current recommendations of other national organizations, such as the American Heart Association (AHA),” says John Wilkins, MD, cardiologist and associate professor of medicine at Northwestern Medicine in Chicago. “It’s good to review evidence and update recommendations accordingly — that’s the nature of science,” he says. The 2016 USPSTF guidelines stated that there was some merit to low-dose daily aspirin for people 50 to 59 who had a 10-year risk of cardiovascular problems higher than 10 percent, who were expected to live longer than 10 years and who were not at higher risk of bleeding. The earlier guidelines also suggested that people 60 to 69 with a 10 percent or higher cardiovascular risk should make an individual decision about taking a daily aspirin.
New Recommendations Focus on Primary Prevention of a Cardiovascular Event
In adults ages 40 to 59 years old with a 10 percent or greater 10-year CVD risk, taking a daily low-dose aspirin has a “small net benefit,” per the statement and the decision on whether to initiate this therapy “should be an individual one.” People willing to take a low-dose aspirin every day and aren’t at increased risk for bleeding are more likely to benefit, according to the committee recommendations. For people age 60 or older, the panel recommends against starting low-dose aspirin for the primary prevention of CVD. “It’s very important to distinguish between primary and secondary prevention,” says Dr. Wilkins. Primary prevention recommendations are intended to prevent the first occurrence of a heart attack, stroke or a cardiovascular disease event, he says. Each year, approximately 605,000 people in the United States have a first heart attack and an estimated 610,000 people experience a first stroke, according to 2021 report from the American Heart Association. “Secondary prevention of cardiovascular disease is preventing recurrent events in people who have already had a heart attack, stroke, or coronary revascularization procedure — like a stent or a bypass surgery,” says Wilkins. “These recommendations only apply to the primary prevention group — they don’t apply in any way to people who already have established cardiovascular disease. The last thing we want is for people who people who have had a procedure, such as having a stent put in, to stop their daily aspirin. That would be very dangerous,” he says. If your doctor has put you on aspirin for any reason, don’t stop taking it without talking with them first, said Wilkins. If you’re unsure if you should continue to take aspirin, talk with your provider.
Evidence Shows the Modest Benefits of Aspirin in Preventing Heart Disease Often Don’t Outweigh Risks
The panel’s proposed recommendations are in line with existing evidence, said Jim Liu, MD, a cardiologist at The Ohio State University. Previous studies through the years have suggested that aspirin offers only a very modest benefit, if any at all, in preventing cardiovascular disease, he said. “In the past three years, there have been a couple of large randomized trials once again studying aspirin for preventative purposes. These newer studies have all found no significant benefit to aspirin when it comes to preventing all-cause mortality or cardiovascular mortality,” said Dr. Liu. These studies did still find a slight benefit in aspirin for preventing nonfatal heart attacks, but that this benefit was mostly seen in higher cardiovascular risk patients who were also at low risk for bleeding, he added.
Why Is Taking a Daily Lose Dose Aspirin Risky for Some People?
“The main risk of aspirin is bleeding complications,” said Liu. Aspirin is an anti-platelet agent and prevents clot formation; in theory, it would help prevent heart attacks and strokes, which can occur from blood clots obstructing flow to either the heart or brain, he said. However, a drawback of this would be that aspirin could increase bleeding, which is an important factor to consider in someone who already has a bleeding tendency or has a known history of bleeding problems, said Liu. “Most bleeding complications seen with aspirin involves gastrointestinal (GI) bleeding, but any bleeding can also occur,” he said.
Over-The-Counter Drugs, Including Aspirin, Can Carry Risks
There can be a misperception that if a drug is sold over the counter and a prescription isn’t necessary, that it is safe in all contexts, and that’s not true, says Wilkins. “Aspirin is an effective medication, and it’s great when used appropriately, but it’s not without significant side effects,” he says. The same with drugs such as acetaminophen or ibuprofen — if taken too long or in the wrong context, these medications can cause serious side effects, says Wilkins.
Expert Tips on Reducing Your Risk of Heart Disease
The American College of Cardiology and American Heart Association offer an online prediction tool to calculate your 10-year risk of heart disease. If your current risk level doesn’t indicate that aspirin is appropriate, there are still many ways to optimize your cardiovascular risk profile and reduce your chances of a first heart attack or stroke, says Wilkins:
Optimize your blood pressure and cholesterol levels. “That can be achieved through lifestyle modifications, and for some people, that may mean medications,” he says.Try to eat a balanced and healthy diet, get the recommended amount of physical activity, and have a BMI within the normal range.Avoid all tobacco products.
