Living Well: Risk of daily aspirin could outweigh benefits
An aspirin a day used to be recommended for heart attack and stroke prevention, but new research and medical recommendations point toward increased risks for healthy people on an aspirin regimen.
To make matters more confusing, updated guidelines between government organizations vary. The U.S. Preventive Services Task Force recommends daily aspirin therapy for people aged 50 to 59 who are not at increased risk of bleeding and who have an increased risk of heart attack or stroke. However, The Food and Drug Administration doesn’t recommend aspirin therapy for the prevention of heart attacks in people who haven’t already had a heart attack, stroke or another cardiovascular condition.
“We used to say, ‘if you’re a 50-year-old man, go ahead and take aspirin, but it’s getting to be a more nuanced decision than that,” said Dr. Elise Sullivan, Family Medicine physician at Memorial Regional Health. “You need to have a comprehensive health assessment of your cholesterol, family history, blood pressure and tobacco use, and then make a plan with your doctor.”
Anyone over 50 years old should be getting this health assessment once a year, she said. And while the federal recommendations about aspirin have changed, she reminds patients who have experienced heart attack or stroke to continue daily aspirin if that’s what their doctor has previously prescribed.
Why the change?
The U.S. Preventive Services Task Force reviewed five medical studies of aspirin for the primary prevention of cardiovascular disease. The task force also reviewed aspirin data for prevention of colorectal cancer.
One 2018 study in the New England Journal of Medicine followed 15,000 people with diabetes — a disease that significantly increases risk of cardiovascular problems — over 7 ½ years and found that the benefits of aspirin were counterbalanced by the risks.
“For every 1,000 people taking aspirin, 11 avoided a serious vascular event (heart attack, stroke, mini-stroke, or cardiovascular-related death). But nine experienced bleeding that was serious enough to result in hospitalization or death, which means the risks and benefits were about the same,” according to a Harvard Medical School report about the study.
In reviewing this and other studies, The USPSTF found adequate evidence that aspirin use in adults increases the risk for GI (gastrointestinal) bleeding and hemorrhagic stroke.
“The USPSTF determined that the harms vary but are small in adults aged 59 years or younger and small to moderate in adults aged 60 to 69 years,” according to the new recommendations. “The USPSTF found inadequate evidence to determine the harms of aspirin use in adults aged 70 years or older.”
In summary, the benefits of daily aspirin therapy don’t outweigh the risk of bleeding in people with a low risk of heart attacks.
“The higher your risk of heart attack, the more likely it is that the benefits of daily aspirin outweigh the risk of bleeding,” according to the Mayo Clinic.
When you hear “family medicine,” think of your family doctor — the person who provides you with general health care for all ages.