The proposed recommendation is based on mounting evidence that the risk of serious side effects far outweighs the benefit of what was once considered a remarkably cheap weapon in the fight against heart disease.
The proposed guidelines would not apply to those already taking aspirin or those who have already had a heart attack. People aged 40-59 who are at a higher risk of developing cardiovascular disease but have no history of it, should consult with their doctor and make an individual decision on whether to start taking the medicine.
The statement was a major reversal in the US medical field, where taking aspirin daily is a widespread practice. The medication thins blood, helping prevent blood clots and reduce the risk of heart attack or stroke.
Since 2016, the Preventive Services Task Force, a government medical expert panel, has recommended a daily dose of aspirin for people in their 50s who have a 10 percent or greater risk of having a heart attack or stroke in the next 10 years. The panel had previously recommended that people in their 60s who were at high risk for cardiovascular disease consult their doctors to make a decision. A low dose is 81 milligrams to 100 milligrams.
Aspirin inhibits the formation of blood clots that can block arteries, but studies have raised concerns that regular intake increases the risk of bleeding, especially in the digestive tract and the brain, dangers that increase with age.
“Daily aspirin use may help prevent heart attacks and strokes in some people, but it can also cause potentially serious harms, such as internal bleeding,” said Task Force member John Wong. “It’s important that people who are 40 to 59 years old and don’t have a history of heart disease have a conversation with their clinician to decide together if starting to take aspirin is right for them.”
Research shows that
the increased risk of bleeding occurs relatively quickly after someone begins regular use of aspirin.
Those who are already taking baby aspirin should talk to their doctor.
“We don’t recommend anyone stop without talking to a clinician, and definitely not if they have already had a heart attack or stroke,” she added.
The guidelines, which are not yet final, have the potential to affect tens of millions of adults who are at high risk for cardiovascular disease, even in the age of COVID. The panel will accept public comments on its recommendations until Nov. 8, although its draft guidance is usually adopted.
Two years ago, the American College of Cardiology and American Heart Association had jointly narrowed their recommendations to say aspirin should be prescribed very selectively for people ages 40 to 70 who had never had a heart attack or stroke. On aspirin, the organizations say “generally no, occasionally yes,” for primary prevention. That advice differs from the task force’s new draft guidance for a cutoff at age 60.
“When we looked at the literature, most of it suggested the net balance is not favorable for most people — there was more bleeding than heart attacks prevented,” said Dr. Amit Khera, one of the authors of the medical groups’ guidelines. “And this isn’t nose bleeds, this can be bleeding in the brain.”
And as long ago as 2014, a Food and Drug Administration review concluded that aspirin should not be used for primary prevention, such as to ward off a first heart attack or stroke, and noted the risks.
The task force, which previously made a universal recommendation for high-risk adults in their 50s to take baby aspirin if their odds of a side effect were low, now proposes that high-risk adults in their 40s and 50s talk to their doctors and make an individual decision about whether to begin a daily regimen. (The panel defined “high-risk” as anyone who has a 10% or greater risk of a cardiovascular event over the next 10 years, according to American College of Cardiology/American Heart Association calculators used to estimate risk.)
With people now better able to control risk factors like high blood pressure and using new drugs to keep cholesterol in check, “there is less room for aspirin now to make a difference,” Lloyd-Jones said. But, he said, “There is still the risk of bleeding.”
Research studies have also indicated that even though aspirin use by people who have not had a heart attack or stroke reduces the risk of those events, it does not lower the number of deaths from heart disease or other causes.
The national task force draft report also questions another use of aspirin, whether it reduces the risk of colorectal cancer, one of the leading causes of cancer deaths in the United States and which has been on the rise among younger adults for reasons that aren’t clear.
In reversing its five-year-old endorsement of aspirin to help prevent colorectal cancer, the report pointed to new data from a randomized controlled study called Aspirin in Reducing Events in the Elderly. In that study, aspirin use was linked to an almost doubling of colorectal cancer deaths after nearly five years of follow-up.
Some experts have not given up on the promise of aspirin, saying there is still “compelling evidence” for its role in cancer prevention.
Dr. Andrew Chan, director of cancer epidemiology at Mass General Cancer Center, said randomized controlled trials show that aspirin inhibits the growth of polyps in the colon and reduces the odds that they will become cancerous.
“This again highlights that we need to think about personalizing who we give aspirin to, and move away from a one-size-fits-all solution,” Chan said.
(Inputs from NYT & AFP)