Expert panel refines guidelines for daily aspirin use to prevent heart attacks

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Expert panel refines guidelines for daily aspirin use to prevent heart attacks

New recommendations caution against the use of daily, low-dose aspirin by older adults. Photo by LizM/Pixabay

An advisory panel of leading physicians no longer recommends daily low-dose aspirin for the prevention of heart attacks in adults age 60 and older, the group announced Tuesday.

The decision is based on new research suggesting that the net benefits of daily aspirin use in this age group are small, the panel, the U.S. Preventive Services Task Force, said in an article published Tuesday by JAMA.

However, for younger adults ages 40 to 59 years who have a greater than 10% risk for developing heart disease over the next decade of their lives — and are at low risk for bleeding-related side effects associated with aspirin use — the decision should be made on an individual bases, the group said.

In addition, the task force has concluded that existing evidence is unclear as to whether aspirin use reduces a person’s risk for colon and rectal cancers, or for dying from tumors in these organs, it said.

“Based on current evidence, the task force recommends against people 60 and older starting to take aspirin to prevent a first heart attack or stroke,” Dr. Michael Barry, task force vice chair, said in a press release.

“Because the chance of internal bleeding increases with age, the potential harms of aspirin use cancel out the benefits in this age group,” said Barry, director of the Informed Medical Decisions Program in the Health Decision Sciences Center at Massachusetts General Hospital in Boston.

The U.S. Preventative Services Task Force is an independent, volunteer panel of national experts in prevention and evidence-based medicine that makes evidence-based recommendations about clinical preventive services such as screenings, counseling services and preventive medications.

“If you are already taking low-dose aspirin because you have had a heart attack, stroke or stenting or you have a history of AFib, continue to take it as directed by your physician,” Dr. Donald M. Lloyd-Jones, volunteer president of the American Heart Association said in a statement.

“This new guidance about low-dose aspirin does not apply to your situation — do not stop taking aspirin without first talking with your doctor,” he said.

Physicians are not obligated to follow the task force’s recommendations, but most do, according to Dr. Kevin Campbell, a cardiologist with Health First Heart and Vascular in Merritt Island, Fla.

“In the past we believed that there was some benefit to using it prophylactically for those without coronary artery disease,” Campbell told UPI in an email.

“However, this recommendation substantiates many of the studies that have come out over the last several years that have shown that the routine use of aspirin for patients without known disease is unlikely to be effective, and in fact may be detrimental,” he said.

This is because aspirin, though widely available and used as an over-the-counter pain reliever, is not without side effects, including gastrointestinal and intracranial, or brain, bleeding, Campbell added.

In his practice, he has been recommending aspirin for secondary prevention only, meaning in patients with “known, documented coronary artery disease.”

In addition to the known side effects associated with regular use, recent studies have found that low-dose aspirin does not reduce the risk for heart disease in everyone who uses it.

The drug may do more harm than good in older adults, research suggests, yet more than half of people age 75 and older in the United States still use it, according to estimates.

Aspirin may, however, reduce the risk for heart attacks in some people with coronary artery disease, which causes a reduction of blood flow to the heart muscle due to build-up of plaque in the arteries, studies indicate.

“I think that [these recommendations] really help us clarify a longstanding question — who should get aspirin for coronary artery disease and how long should it be given,” Campbell said.

“Those without coronary artery disease should not take aspirin — particularly those over the age of 60, as the risk of bleeding outweighs any potential benefit,” he said.

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