Rethink That Daily Aspirin
Aspirin seems like such a benign drug. After all, countless millions have used it since it was invented in 1899 so it must be safe, right? Not necessarily.
The fact is that aspirin, like any drug, can have potential side effects. This is why the U.S. Preventive Services Task Force (USPSTF) announced new draft recommendations for those considering taking it to prevent heart attacks or strokes.
So our primary care doctors at Cohen Medical Associates in Delray Beach want to explain their recommendations. We also want to share why adults 60 and older should not begin taking aspirin as a preventive measure.
The earlier thinking about daily aspirin
For years, aspirin has been touted as a magic pill that can prevent everything.
For example, a 2016 study from the University of Southern California showed that a daily low-dose (81 mg.) aspirin tablet offered significant heart protection. It also offered a 30% reduced risk of cancer and a 17% reduced risk of stroke.
The researchers found that 81 mg. of aspirin daily reduces the death rate from heart disease by 22%. This result was most pronounced in people aged 50 and over.
Other studies have suggested a reduced risk of breast cancer, colorectal and intestinal cancers, liver, ovarian, prostate, head and neck cancers, and melanoma, as well as Alzheimer’s disease.
This led to a general view that the risk of a daily low-dose aspirin was far outweighed by its benefits.
That view has come under increasing scrutiny, however.
Aspirin thins the blood. This makes blood platelets less likely to clump together to form blood clots in the narrowed arteries found in those with cardiovascular disease (CVD). This quality is why aspirin became popular as a preventive for heart attacks and strokes.
Unfortunately, this is the reason for concern in follow-up studies about the risks of internal bleeding associated with daily low-dose aspirin use. Such bleeding can be serious enough to require hospitalization or a blood transfusion.
A 2019 study, for example, found that people without heart trouble who took a daily aspirin had a lower risk of heart attack, stroke, and death. The increased risk of bleeding in the intestinal tract or the brain, however, cancels out these benefits.
Researchers at King’s College Hospital in London performed a meta-analysis of 13 studies. These included 164,225 participants, none of whom had CVD when the studies began.
“For every 256 patients treated with aspirin for five years, one heart attack, stroke, or death from cardiovascular disease would be prevented,” Dr. Sean Zheng, lead author of the study and an academic clinical fellow in cardiology at King’s College, told CNN. “On the other hand, for every 210 patients treated with an aspirin over the same period, one would have a serious bleeding event.”
Other recent studies have raised similar concerns, which led to last month’s USPSTF’s revised recommendations.
The latest thinking on daily aspirin
For those who experienced a heart attack or stroke, significant evidence shows that daily low-dose aspirin is effective in lowering the risk of a second event.
For those without CVD, however, the risk of gastrointestinal bleeding isn’t a small one. Like kids on a seesaw, on one end (increasing age) the bleeding risk rises as the potential benefits (lower heart attack and stroke risk) begin to lower on the other.
The USPSTF’s proposed guidelines suggest that for those ages 60 and over, aspirin use isn’t worth the risk.
“If you don’t have a history of heart attack and stroke, you shouldn’t be starting on aspirin just because you reach a certain age,” said USPSTF task force member Chien-Wen Tseng in a statement.
Both the American Heart Association (AHA) and the American College of Cardiologists (ACC) agree. They recommend against the daily use of low-dose aspirin to prevent a first heart attack or stroke.
What to do now
If you’re taking aspirin because you’ve already had a heart attack or stroke, don’t stop.
If you’ve been taking daily low-dose aspirin for its heart-protective benefits, don’t stop without discussing it with us. It could be dangerous. A 2017 Swedish study published in Circulation found that those who suddenly quit their long-time aspirin habit had a 37% increased risk of a cardiovascular event.
There are ways to help minimize that risk as well as the risk of gastrointestinal bleeding with aspirin use. Be sure to let us know before stopping daily use of aspirin.
If you are at risk of CVD and thinking of starting a daily aspirin to prevent a cardiovascular event, check with us first. We can help you evaluate your individual risks against any possible benefits.
Also, when we ask about medications, tell us if you’re using aspirin or any other over-the-counter (OTC) drug. Remember that all medications, including vitamins and herbal supplements, have risks.