The U.S. Preventive Services Task Force has finalized its latest recommendations on low-dose aspirin regimens and now says people over 60 should not start taking aspirin daily for primary prevention of heart problems, in most cases.
If you are between the ages of 40 and 59, the USPSTF leaves it to you and your doctor to decide whether you should take daily aspirin in specific circumstances.
“If you’re really healthy, if you’re a healthy 40-year-old with no major risk factors, you’ll do more harm than good with daily aspirin. Your risk of bleeding will outweigh the benefits,” said Dr. Stephen Nissen, chairman of cardiovascular medicine. at the Cleveland Clinic, which did not participate in the new guidelines. “People need to understand that aspirin is not a completely benign or innocent therapy.”
But if you have had a heart attack, stroke or other heart or circulatory problems and your doctor has prescribed you daily aspirin, don’t stop taking it – talk to them instead about what the new recommendations mean to you.
“Aspirin is important in secondary prevention. If you have a stent, if you have had a myocardial infarction or a stroke, aspirin works for all of these people. It provides a modest but definite benefit,” Nissen said.
The USPSTF is a group of independent disease prevention experts and medical experts from across the country who provide recommendations to help physicians make decisions. Their recommendations also affect insurance companies’ recovery decisions.
Aspirin works by preventing your body from producing certain natural substances that cause pain and swelling. It can also protect your blood from clotting, which is why doctors have been recommending it for years to prevent cardiovascular problems such as heart attacks or strokes.
According to recommendations published Tuesday in JAMA, your doctor may ask you to consider an aspirin regimen if you are in the age range of 40 to 59 and have a 10% or 10% higher 10-year risk of cardiovascular disease.
This means that your chances of having a heart attack or stroke in the next 10 years are higher than normal based on a calculation that includes factors such as age, gender, race, cholesterol levels, blood pressure, medication use, diabetes and smoking status. According to the working group, daily aspirin “has little net benefit”, especially for this group.
The studies led to a change in direction
The updated recommendations are based on a working group review of several significant randomized clinical trials on the use of low-dose aspirin that found a lower risk of myocardial infarction and stroke but no reduction in mortality. Low doses of aspirin have also been linked to an increased risk of bleeding.
The last time the working group updated these recommendations was in 2016, it suggested that daily aspirin may be helpful in preventing colorectal cancer. But updated guidelines say there is limited evidence that it reduces the risk of colorectal cancer risk or mortality.
The 2016 guidelines say there is some benefit to daily aspirin use for those 50 to 59 who have had a 10-year risk of cardiovascular problems above 10%, who are expected to live longer than 10 years and who are not at higher risk of bleeding.
The 2016 guidelines also suggest that people aged 60 to 69 with a 10% or higher cardiovascular risk must make an individual decision about taking daily aspirin.
Bleeding problems in people without high-risk conditions such as peptic ulcer, NSAID use or corticosteroid use are rare, the working group said, but the risk increases with age. “Modeling data suggest that it may be reasonable to consider stopping aspirin use around age 75.”
Cardiovascular disease is the number one killer in the United States, causing more than 1 in four deaths, according to the U.S. Centers for Disease Control and Prevention. “The more data we get, the more we see that although the risk of coronary heart disease and heart attack increases with age, the risk of bleeding seems to increase even faster,” said Dr. James Siredu, medical director of Harrington Heart. Vascular Institute at the University Hospitals Bedford Medical Center, which did not work on the guidelines.
Earlier changes in heart guidelines
These are not the only recommendations for daily use of aspirin. The new USPSTF guidelines are now more in line with the guidelines of the American College of Cardiology / American Heart Association and its recommendations for the average person who has never had a heart event, according to Dr. Roger Blumenthal, co-chair of the committee behind the ACC / AHA guidelines.
“When you look at all the recent research, it seems that the modest benefits of aspirin and otherwise low-risk individuals usually negate the increase in long-term problems with GI, aspirin bleeding,” Blumenthal said. “While we said that aspirin could be considered to be given to someone who has never had a heart attack or stroke, this should probably be the last thing on the list of priorities.
Aspirin may still have a place in heart health, said Dr. Donald Lloyd-Jones, president of the American Heart Association.
“Aspirin can still make sense in some situations where we don’t do so well in controlling cholesterol, blood pressure for some reason,” Lloyd-Jones said. “Maybe drugs are too expensive or the health system in a country can’t spread these things, aspirin may still make sense, but I think in a lot of situations in that country where people have good access to health care and they’re taking into account other risk factors, aspirin now makes much less sense. “
You can take other steps to help your heart health with just a little effort, said Dr. Roy Buchinsky, director of wellness at Ohio University Hospitals, who was not involved in the new USPSTF guidelines.
“We always preach that DNA is not your destiny, which means there are so many things we can do in terms of lifestyle that can reduce chronic disease and the risk of heart disease and stroke,” Buczynski said. .
It offers a good diet with “real food” 90% of the time and 10% “fun food”. Aim for at least 150 minutes of physical activity a week, sleep a lot and focus on 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 is even better if the patient does not need them.
“It is much easier to prevent than to cure,” Buchinski said.
Add Comment