Millions should stop using aspirin for heart health

Henrietta Brewer
July 24, 2019

The millions of people who take aspirin every day to prevent heart attacks probably need to have serious conversations with their doctors about whether they truly need it.

"Although prior American Heart Association and American College of Cardiology guidelines recommended aspirin only in persons without elevated bleeding risk, the 2019 guidelines now explicitly recommend against aspirin use among those over the age of 70 who do not have existing heart disease or stroke", said senior author Christina C. Wee, a general internist and researcher at BIDMC and Associate Professor of Medicine at Harvard Medical School. The trials led the American Heart Association and the American College of Cardiology to change clinical practice guidelines and to warn that any benefit from taking a daily low-dose aspirin would be more than offset by the danger of internal bleeding and other side effects in people considered to be at low or moderate risk for heart disease. "Certainly there are harms associated with indiscriminate aspirin use for primary prevention in low risk populations".

- Individuals over 70 who don't have heart disease - or are younger; however, at increased risk of bleeding - should keep away from daily aspirin for prevention. About 6.6 million of those Americans were doing so on their own - a doctor never recommended it.

The study also finds that almost half of all Americans over 70 - that's about 10 million people - were taking a daily aspirin in hopes of staving off a heart disease diagnosis.

Almost half (44.6%) of adults aged 70 or older without cardiovascular disease said they were using aspirin to prevent heart disease.

Since the data were representative of the rest of the nation, the researchers interpreted that would mean that, among adults age 40 and older without cardiovascular disease, 23.4% - or about 29 million people nationwide - would report taking daily aspirin for the prevention of cardiovascular disease, based on the survey responses.

"And more concerning, one-half of adults over age 70 who don't have heart disease or stroke are taking aspirin regularly".

"Many patients are confused about this", said Dr. Colin O'Brien, a senior intern medicine resident at Beth Israel who led the most recent study from Harvard and Beth Israel Deaconess Medical Center.

How many people need to get that message? For many years, he said, there's been the perception that low-dose aspirin can reduce strokes and heart attacks with little risk of harm - the reasoning being it's "just" low-dose aspirin.

"Aspirin is frequently thought of as an over-the-counter medication and it may not appear on a patient's medication list", she said.

Wee is not recommending that everyone stop taking aspirin. The problem is that for those who don't already have heart disease, aspirin comes with some unsafe side effects, such as brain bleeds, experts say.

"We hope that more primary care doctors will talk to their patients about aspirin use, and more patients will raise this with their doctors", O'Brien said. Rather, she said, before making any changes, people should discuss the issue with their doctors.

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