Health Tips Tuesday: updated guidance on daily aspirin

SPRINGFIELD, Mass. (WGGB/WSHM) - The United States Preventive Services Task Force has issued new guidance no longer recommending those 60 and older take aspirin daily to prevent a heart attack or stroke.

This week, Dr. Amir Lotfi, chief cardiologist at Baystate Health, discussed the changes in the guidance.

Why this new guidance and what does this mean for those 60 and older who have been taking aspirin and for those with a history of cardiovascular issues?

Lotfi: “So David, I think you make a very good point. There’s two types of palpitation. There is the primary prevention. That means you’ve never had a heart attack or you’ve never had a stroke or any cardiovascular issue and that’s where we’re going to focus on initially. There’s been multiple studies now looking at aspirin as primary prevention in individuals who never had a heart attack and what they have discovered is that, because every medication has a side effect, when you balance the bleeding versus the decrease in non-fatal heart attacks, there didn’t seem to be any significant benefit in taking aspirin daily for prevention, so that’s the rational why the task force claims that for primary prevention, you don’t need to take aspirin. Remember, this is general population, not individual, so that’s why it’s important to always have a discussion with your physician regarding ‘Am I a good candidate for aspirin for primary prevention?’ For secondary prevention, especially for people who have coronary disease or a history of stroke, aspirin continues to be the main staple for secondary prevention to decrease the future risk of a heart attack and especially if you have a coronary stent, never stop your aspirin without having the discussion with your physician or cardiologist.”

The task force also issued new guidance saying that 40- to 59-year-olds should only take aspirin if they have a high risk of cardiovascular disease. What are the risks of taking aspirin?

Lotfi: “So one of the major risks of aspirin is bleeding and one of the major risks of the bleeding side is gastrointestinal system, especially from the stomach or the intestine and rarely bleeding in the brain, but the major risk is gastrointestinal bleeding and that’s what kind of offsets the benefit of aspirin for primary prevention, so that’s where from a balance point of view: risk versus benefit. It doesn’t seem that the benefit outweighs the risks in this situation.”

Should you stop taking aspirin because of this guidance?

“No. Every person who’s on aspirin should have a discussion, a meaningful discussion, and say again, this is for primary prevention and secondary prevention. If you’re thinking about it, have a discussion with your physician saying for primary prevention, ‘Am I in the low-risk category that I should stop taking aspirin?’ and if you’re in the secondary prevention, do not take your aspirin. If you have thoughts about it, talk to your cardiologists because that’s key and if you’re not on aspirin, talk to your physician to say ‘Am I in the high-risk group that the benefit outweighs the risk of taking aspirin?’”

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