People over the age of 60 should no longer consider taking a daily low-dose or baby aspirin to prevent a first heart attack or stroke, according to a draft recommendation issued by the U.S. Preventive Services Task Force Tuesday.
The announcement marks a change in the 2016 Task Force guidance that recommended aspirin therapy in certain men and women to lower cardiovascular risk. But more recent evidence suggests it also could cause harm, including bleeding in the stomach, intestines, and brain – a risk that increases with age and can be life-threatening.
The task force said people ages 40 to 59 who are at higher risk for cardiovascular disease should decide with their clinician whether to start taking aspirin. Once they turn 60, they should not start taking it because the risk of bleeding cancels the benefits of preventing heart disease.
The new recommendation only applies to people who are not already taking a daily aspirin. Doctors have long recommended daily low-dose aspirin for many patients who have had a heart attack or stroke. The task force guidance does not change that advice.
“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, a primary-care expert at Tufts Medical Center. “It’s important that people who are 40 to 59 years old and don’t have a history of heart disease have a conversation with their clinician to decide together if starting to take aspirin is right for them.”
The task force previously said a daily aspirin also might protect against colorectal cancer for some adults in their 50s and 60s, but the updated guidance says more evidence of such a benefit is needed.
The guidance was posted online to allow for public comment until Nov. 8. The group will evaluate that input and then make a final recommendation.
The new recommendations not only stemmed from emerging research suggesting aspirin’s potential harm, but also from advances in cardiovascular treatment, said Dr. Guy L. Mintz, Northwell Health’s director of cardiovascular health and lipidology at Sandra Atlas Bass Heart Hospital.
There are now better medications for cholesterol, hypertension and diabetes that lower cardiovascular risk, heart failure and improve kidney function, he said. There are also more tools to identify and treat insulin resistance and sleep apnea, as well as smoking cessation, which also affect heart health.
“With all these advances, the need for aspirin in all patients has been negated,” Mintz said. “There is benefit for aspirin use in some patients, and that is why patients on aspirin should not stop their aspirin and consult their doctor.”
However, some doctors are confused by the new guidance. What should they tell their patients who have been taking aspirin for a decade and are turning 60, asked Dr. Elizabeth Klodas, a cardiologist and founder of Step One Foods, a meal and snack program.
“I understand where they’re coming from but they’re inadvertently creating confusion for practicing physicians,” she said. “They really need to address the transition of someone who has been on aspirin because they meet criteria and then they get older. What are we supposed to do?”
Aspirin is best known as a pain reliever but is also a blood thinner that can reduce the chance of blood clots. It also has risks, even at low doses – mainly bleeding in the digestive tract or ulcers, both of which can be life-threatening.
Contributing: Associated Press. Follow Adrianna Rodriguez on Twitter: @AdriannaUSAT.
