Aspirin. Your Heart’s Best Friend, or Maybe Not

New research highlights dangers for over 60's

Heart disease is the leading cause of death in the U.S., and according to the most recent data available, 29 million adults in the U.S. take aspirin daily to prevent heart disease even if they don’t have a history. Most doctors recommend a daily dose of child-sized aspirin for patients that are exhibiting elevated signs of risk for Cardiovascular Disease (CVD). All that may however be about to change with new research just released, accompanied by an advisory.

Doctors should no longer prescribe daily doses of aspiring to pre-CVD patients because of the increased risk of bleeding, a risk that increases with age.

We’ve known for a long time that aspirin reduces risk for those who’ve already experienced a heart attack or stroke, and logic and research supported the idea that administering aspirin to a patient prior to a cardiac event would reduce the likelihood and/or severity of CVD or stroke.

Simply put, aspirin works by thinning your blood (an anticoagulant), making the blood less likely to form clots and thinner blood requires less effort to circulate, so the heart doesn’t have to pump as hard. Benefits were seen to extend not only to CVD but also to the incidence of strokes.

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Now, the U.S. Preventive Services Task Force, an independent panel of experts, has just released an updated draft recommendation that says most adults should not take aspirin to prevent first heart attacks or strokes.

The newly updated guidance recommends that adults in their 40s and 50s only take aspirin as a preventive measure if their doctors determine they are at higher risk for heart disease and that aspirin may lower the risk without significant risk of bleeding. Previous guidance didn’t address anyone younger than 50.

People ages 60 or older are now advised not to start taking aspirin to prevent first heart attacks or strokes.

So what has changed?

The timing of the new advisory couldn’t have been worse. It follows on the heels of an Israeli study and this study that points to the efficacy of aspirin for treating severe Covid and mounting evidence that a daily dose of aspirin may reduce the risk of infection from the virus.

The new advisory is seen by many as an attempt to smear aspirin as a cheap and effective treatment for Covid, forcing people instead to opt for more costly treatment options. They cite the recent examples of Ivermectin and Hydroxychloroquine to support the pattern, but mistakenly so, as data shows neither drug to be effective.

Aspirin does however appear to reduce the risk of severe Covid for some patients.

Conspiracies, baseless or otherwise, aside, the new advisory is still under review, pending input from providers. We have known for many years that aspirin poses a risk for bleeding in some individuals and that this risk increases for the elderly. Every doctor that prescribes aspirin takes these risk factors into consideration when treating a patient.

Aspirin remains one of the safest and well-tolerated drugs we have at our disposal. Poll any doctor over the age of 40 and you’ll find many drink an aspirin each day, that’s how entrenched the belief in the drug has become and it is available without prescription in almost every country on the planet as an over-the-counter (OTC) medicine.

So how should you as a patient, respond to the latest advice? If you do fall into the new categories (60+) defined as high risk, discuss your medication regimen with your doctor. Patients should be aware that these advisories apply to patients that have not yet experienced CVD or suffered a stroke.

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

If you’re self-medicating with aspirin, there are a few things you should consider.

  • Don’t simply start using aspirin because you’ve reached a certain age and if you’re over 70, definitely don’t take aspirin unless advised by your doctor.
  • If you’re a candidate for CVD, in other words, if you smoke and drink heavily, if you have elevated blood pressure, high BMI, or suffer from obesity and have a family history of CVD, aspirin may benefit you, but again, a doctor is best placed to advise you.
  • Aspirin will thin your blood, but won’t address the contributing factors that result in CVD. It won’t drop your blood pressure, lower your cholesterol or help you lose weight. Eventually, these factors will negate any positive effect aspirin may have on your heart.
  • You may, inadvertently be compromising your health if you are over 50 and risk ulcers and bleeding. Your doctor is best qualified to properly assess this risk.

Dr. Erin Michos, an associate director of preventive cardiology at the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, who isn’t part of the task force, had this to say about widely known recommendations that endorsed daily aspirin use for decades;

“We’ve gotten a lot better with other medical therapies, and the aspirin recommendations were developed during trials conducted before statins were widely used and smoking was more widespread. The incremental benefit of aspirin in contemporary medicine does not provide as strong of a benefit for primary prevention as it once would.”

There is no magic medication for negating your risk of heart disease and stroke, and aspirin, although beneficial, won’t make you bulletproof. You will need a multifaceted approach that includes a healthy diet and regular exercise, and yes, perhaps an aspirin a day. Talk to your doctor.

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