New Guidelines Under Consideration for Aspirin and Heart Disease

Since the 1980s, doctors have been prescribing aspirin to help prevent heart attacks and strokes, especially in individuals at high risk. But in recent years, studies have shown that aspirin, which is often prescribed because it helps inhibit blood clot formation that can block your arteries, may create other risks especially for people 60 and older.

One of the country’s foremost medical groups is considering new guidelines around aspirin recommendations after studies published in the New England Journal of Medicine in 2018 found that aspirin therapy may not benefit people who haven’t had a previous heart attack or stroke.

What if I’m taking aspirin?
First, don’t do anything before you speak with your physician. If you’ve been taking aspirin on your doctor’s orders, keep taking it. You should never stop taking a drug or start a new drug without consulting with your physician. Your MDVIP-affiliated doctor has personalized your care – including your prescriptions and is in the best position to advise you on the treatment you’re receiving. Talk to your doctor at your next visit.

Why is the change being proposed?
Of particular concern to the U.S. Preventive Services Task Force, the organization behind the new proposed guidelines, is the risk of bleeding, especially in older Americans. While aspirin can help prevent blood clots, it can also increase the risk for internal bleeding, resulting in hemorrhagic stroke or bleeding in the brain or gastrointestinal system.

In the studies referenced above, researchers found that patients who did not take aspirin had a slightly higher survival rate and slightly lower dementia and physical disability than the group who took aspirin. That means the benefit from taking aspirin may not outweigh the risk – at least for certain groups.

While a primary preventive drug for cardiovascular events for 40 years, aspirin often plays second fiddle to newer drugs. As our Director of Education and Clinical Excellence Lou Malinow, MD, an MDVIP affiliate and lipidologist, said recently: 

“Now that we have statins, non‐statin medications to lower cholesterol, blood pressure medications which are very effective, and medications to control insulin resistance/diabetes many of which also reduce cardiac risk, the bar to show a benefit to any additional intervention like aspirin is much higher.”

The new proposed changes affect patients who are 60 and older who have not had a heart attack or stroke and are taking aspirin as a preventive measure. In its draft, the USPSTF is recommending against starting low-dose aspirin use for primary cardiovascular disease prevention in adults 60 and older who have not suffered a heart attack or stroke.

For those between 40 and 59, the panel says patients who have a 10 percent or greater 10-year risk for cardiovascular disease may still benefit from the therapy if they are not at increased risk for bleeding.

Doctors recommend drugs for primary prevention to help prevent disease from taking place in at-risk patients. Secondary preventive measures usually refer to screening for disease or are designed to keep a disease that’s typically in early stages from getting worse. Tertiary preventive measures are designed to improve quality of life and reduce symptoms of an existing disease. The USPSTF draft recommendations affect primary prevention. 

What happens with the guidelines next?
These new guidelines are a proposal. The USPSTF is accepting public comments through early November and will issue new guidance at a later date. In the past, the organization’s guidelines become generally accepted practice among medical practitioners, but not always. 

Physicians have to weigh the pros and cons of such guidelines, and your physician may determine that your risk is less than the benefit, or vice versa, that you may receive from a particular treatment. 

That’s why it’s always a good idea to check with your MDVIP-affiliated physician before you make a change.