Advice shifting on aspirin use for preventing heart attacks

Aspirin pills. Credit: MGN.

Older adults without heart disease shouldn't take daily aspirin to prevent a first heart attack or stroke.

Posted: Oct 12, 2021 1:40 PM

Older adults without heart disease shouldn't take daily low-dose aspirin to prevent a first heart attack or stroke, an influential health guidelines group said in preliminary updated advice released Tuesday.

Bleeding risks for adults in their 60s and up who haven't had a heart attack or stroke outweigh any potential benefits from aspirin, the U.S. Preventive Services Task Force said in its draft guidance.

For the first time, the panel said there may be a small benefit for adults in their 40s who have no bleeding risks. For those in their 50s, the panel softened advice and said evidence of benefit is less clear.

The recommendations are meant for people with high blood pressure, high cholesterol, obesity or other conditions that increase their chances for a heart attack or stroke. Regardless of age, adults should talk with their doctors about stopping or starting aspirin to make sure it’s the right choice for them, said task force member Dr. John Wong, a primary-care expert at Tufts Medical Center.

“Aspirin use can cause serious harms, and risk increases with age,’’ he said.

If finalized, the advice for older adults would backtrack on recommendations the panel issued in 2016 for helping prevent a first heart attack and stroke, but it would be in line with more recent guidelines from other medical groups.

The task force previously said certain people in their 50s and 60s may want to consider a daily aspirin to prevent a first heart attack and stroke, and that they might get protection against colorectal cancer, too. The updated guidance says more evidence of any benefit for colorectal cancer is needed.

Doctors have long recommended daily low-dose aspirin for many patients who already have had a heart attack or stroke. The task force guidance does not change that advice.

The guidance was posted online to allow for public comments until Nov. 8. The group will evaluate that input and then make a final decision.

The independent panel of disease-prevention experts analyzes medical research and literature and issues periodic advice on measures to help keep Americans healthy. Newer studies and a re-analysis of older research prompted the updated advice, Wong said.

Aspirin is best known as a pain reliever but it is also a blood thinner that can reduce chances for blood clots. But aspirin also has risks, even at low doses — mainly bleeding in the digestive tract or ulcers, both of which can be life-threatening.

Dr. Lauren Block, an internist-researcher at Feinstein Institutes for Medical Research in Manhasset, New York, said the guidance is important because so many adults take aspirin even though they have never had a heart attack or stroke.

Block, who is not on the task force, recently switched one of her patients from aspirin to a cholesterol-lowering statin drug because of the potential harms.

The patient, 70-year-old Richard Schrafel, has high blood pressure and knows about his heart attack risks. Schrafel, president of a paperboard-distribution business, said he never had any ill effects from aspirin, but he is taking the new guidance seriously.

Rita Seefeldt, 63, also has high blood pressure and took a daily aspirin for about a decade until her doctor told her two years ago to stop.

“He said they changed their minds on that,’’ recalled the retired elementary school teacher from Milwaukee. She said she understands that science evolves.

Wong acknowledged that the backtracking might leave some patients frustrated and wondering why scientists can’t make up their minds.

“It’s a fair question,’’ he said. ‘’What’s really important to know is that evidence changes over time.’’

Mississippi Coronavirus Cases

Data is updated nightly.

Cases: 497379

Reported Deaths: 9907
CountyCasesDeaths
Harrison34085530
DeSoto31806398
Hinds31796621
Jackson24303377
Rankin21852387
Lee15413233
Madison14513278
Jones13770241
Forrest13401250
Lauderdale11936314
Lowndes10908184
Lamar10461135
Pearl River9428237
Lafayette8450137
Hancock7690126
Washington7361156
Oktibbeha7110129
Monroe6713173
Warren6635175
Neshoba6606204
Pontotoc6603101
Panola6458131
Marshall6378132
Bolivar6264145
Union595194
Pike5780152
Alcorn5630100
Lincoln5416134
George490479
Scott470698
Tippah464981
Prentiss464181
Leflore4626143
Itawamba4590104
Adams4570119
Tate4539109
Copiah444691
Simpson4419116
Wayne438572
Yazoo437586
Covington427194
Sunflower4215104
Marion4206107
Coahoma4114104
Leake407287
Newton380879
Grenada3691108
Stone358264
Tishomingo355991
Attala330189
Jasper328065
Winston312891
Clay305875
Chickasaw296567
Clarke290294
Calhoun277645
Holmes266587
Smith262550
Yalobusha232347
Tallahatchie225251
Walthall217663
Greene215448
Lawrence211140
Perry204555
Amite203454
Webster201645
Noxubee184940
Montgomery178956
Jefferson Davis170642
Carroll167338
Tunica158539
Benton147038
Kemper141241
Choctaw133026
Claiborne131037
Humphreys128838
Franklin119128
Quitman106227
Wilkinson104339
Jefferson94234
Sharkey64020
Issaquena1937
Unassigned00

Alabama Coronavirus Cases

Cases: 811551

Reported Deaths: 15101
CountyCasesDeaths
Jefferson1138721885
Mobile720161315
Madison51829685
Shelby37203339
Baldwin37018538
Tuscaloosa34853599
Montgomery33879718
Lee23097239
Calhoun22095468
Morgan20584368
Etowah19727496
Marshall18224298
Houston17270405
St. Clair15884337
Cullman15257289
Limestone15177197
Elmore14944283
Lauderdale14060294
Talladega13653270
DeKalb12530258
Walker11055363
Blount10071174
Autauga9874146
Jackson9760177
Coffee9171188
Dale8850180
Colbert8768200
Tallapoosa7028194
Escambia6714127
Covington6661179
Chilton6571160
Russell623458
Franklin5926105
Chambers5553142
Marion4942126
Dallas4848199
Clarke472681
Pike4713105
Geneva4557126
Winston4456101
Lawrence4247116
Bibb421186
Barbour355274
Marengo333889
Monroe329062
Randolph324663
Butler323694
Pickens313479
Henry310365
Hale308586
Cherokee299257
Fayette289779
Washington250850
Cleburne245758
Crenshaw243075
Clay238867
Macon229862
Lamar214846
Conecuh185051
Coosa177338
Lowndes173061
Wilcox166738
Bullock151744
Perry137940
Sumter130738
Greene125344
Choctaw86527
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