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Health & Fit New Guidelines for Adults 60 and Older Taking Aspirin for Heart Disease Prevention

18:30  16 october  2021
18:30  16 october  2021 Source:   prevention.com

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New suggestions for those over 60 taking aspirin to prevent heart disease were released by the United States Preventive Services Task Force in a statement. © Grace Cary - Getty Images New suggestions for those over 60 taking aspirin to prevent heart disease were released by the United States Preventive Services Task Force in a statement.
  • Official recommendations for taking aspirin to prevent cardiovascular disease should change, according to the United States Preventive Services Task Force.
  • The suggested changes say that no one over 60 should take aspirin as a preventative measure, and people between 40 and 59 who are at risk of heart disease should discuss with their doctor.
  • Taking aspirin on a regular basis increases risk for internal bleeding.

The longstanding suggestion to take a daily aspirin to prevent cardiovascular disease is being challenged and may soon change. The United States Preventive Services Task Force posted a draft statement outlining new thinking that would adjust the current recommendations for all people over 60, as well as people between 40 to 59 who are at risk of cardiovascular disease. The USPSTF posted the proposed changes online for public comment, and will be open until November 8, 2021 at 11:49 pm EST.

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First, what is cardiovascular disease?

Cardiovascular disease most often refers to heart attacks or strokes, which are caused by blood clots that form inside our arteries, explains Elizabeth Klodas, M.D., cardiologist and founder of Step One Foods.

Cardiovascular disease accounts for one in three deaths and is the leading cause of death in the United States. Approximately 605,000 Americans have a first heart attack and 610,000 experience a first stroke every year, according to the USPSTF.

Age and genetics are some of the strongest, non-modifiable risk factors for cardiovascular disease, explains Sanjiv Patel, M.D., board-certified interventional cardiologist at MemorialCare Heart and Vascular Institute. Other risk factors that people have more control over include smoking, inactivity, high cholesterol, high blood pressure, high blood sugar or diabetes, excess weight, and poor diet, says Dr. Klodas.

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Which aspirin recommendations might change?

Prior to the proposed changes, a 2016 statement recommended that adults ages 50 to 59 who are at risk of cardiovascular disease but without a history of it (and who are not at increased risk for bleeding), should take a low-dose aspirin to prevent cardiovascular disease (this is called primary prevention).

Additionally, prior recommendations suggested that high-risk adults ages 60 to 69 who don’t have a history of cardiovascular disease should make individual decisions with their healthcare provider to determine what’s right for them, according to the USPSTF.

What are the new recommendations likely to say?

The new suggestions from USPSTF significantly limit the use of aspirin as a preventative measure. It’s no longer recommended that anyone, even those at risk, start taking aspirin for heart disease prevention without a doctor’s specific recommendation.

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First, anyone 60 or older without a history of cardiovascular disease should not take low-dose aspirin at all for the primary prevention of cardiovascular disease. Evidence suggests this has no benefit, according to the USPSTF.


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The USPSTF’s other recommendation is for adults ages 40 to 59 years old who are at risk but do not have a history of cardiovascular disease. This group should discuss with their doctors to determine whether a low-dose aspirin is a good choice for them. However, evidence suggests there is only a very small benefit to taking aspirin under these circumstances as a primary prevention of cardiovascular disease, according to the USPSTF.

It’s important to note that these changes are not geared towards patients who have already had a cardiovascular episode, such as a heart attack, stent, or bypass surgery and have already been instructed by their doctor to take aspirin as a secondary form of prevention, warns Dr. Virani. Aspirin is often suggested for those no older than 70 who have had a cardiovascular event, and have a low risk of bleeding, he says. If there is any confusion about what you should be taking for your particular case, he encourages talking to your healthcare provider before stopping or starting any new medications.

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What’s the problem with aspirin?

Aspirin used to be considered a safe way to prevent heart disease in people at risk. But experts have been questioning this connection, and pointing out the risks of aspirin itself, explains Dr. Virani. Even though aspirin is an over the counter drug, it can cause internal bleeding. This risk increases with age, so it’s important for older people to avoid taking aspirin without careful evaluation from their healthcare provider, he says.

“Those side effects are not trivial. Other preventative measures may have side effects, but not as severe as aspirin,” Dr. Virani says.

Aspirin can irritate the lining of the stomach, which can lead to bleeding in the digestive system. But because it’s a blood thinner, it can increase the risk of bleeding anywhere more likely, Dr. Klodas says.

This isn’t the first time using aspirin to prevent cardiovascular disease has been seriously questioned, and the USPSTF conducted a systematic review of aspirin’s effectiveness before making the new recommendations. Among the previous red flags were an article published in JAMA in 2019: It suggested that those who have had a heart attack, stroke, placement of a coronary artery stent, or coronary artery bypass graft surgery could benefit from a daily dose of aspirin, while those without any history of cardiovascular disease have no benefit from this, and could potentially harm themselves more. Additionally, the American Heart Association currently suggests taking aspirin to prevent a cardiovascular event only after speaking with your doctor about your potential risks and benefits.

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“I don’t think people should be making those decisions on their own. They should go talk to their clinician,” Dr. Virani says. “These conversations should happen in a clinician's office.”

But, it is acceptable to take aspirin on occasion for other reasons, such as pain relief, assuming it doesn’t interact with other medications, says Dr. Patel. Taking aspirin in the short-term is not going to hurt you, but long-term everyday use is what’s concerning, he says.

What are other preventative measures you can take for cardiovascular disease?

Other, lower-risk therapies may be recommended by your healthcare provider; those might include blood pressure control, statins to lower your risk of heart attack or stroke, or lifestyle changes, like a eating a healthier diet and adding more physical activity, Dr. Virani says. These are preferred as primary preventative measure, he notes.

“Aspirin does nothing to lower blood pressure, improve cholesterol profiles, or improve blood sugar control,” explains Dr. Klodas. “It also does not prevent blockages from forming. The only thing that aspirin does is to mildly thin the blood which then reduces the risk of clot formation, which is the precursor of heart attack or stroke.”

Instead, she suggests focusing on modifiable risk factors through diet (like high cholesterol and blood sugar) for your best chance at preventing a cardiovascular episode. “The best scenario is to not need aspirin in the first place. Eighty percent of heart disease is preventable,” Dr. Klodas says. “We all have a lot of power over our health destinies through the way we live–and frankly, it’s way more than what we get through taking a daily aspirin.”

Dr. Patel also encourages changing up your daily habits to better your chances of avoiding a cardiovascular event, without the need for aspirin. He suggests long-term changes like sleeping regularly for seven to eight hours a night, performing both strength and cardio exercises, eating a variety of fruits and vegetables, and avoiding smoking, drug use, and excess alcohol use.

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