Updated Aspirin Heart Guidelines: What do they mean for you?
The invention of aspirin was a watershed moment for the medical community.
It was developed in the late 19th century as a pain reliever and fever reducer, but has evolved into a popular supplement for heart health. Researchers discovered that aspirin has the ability to prevent the formation of blood clots.
Soon after, doctors began recommending as much as 100mg daily to prevent heart attacks in men, ischemic strokes in women (most common type of stroke), and colorectal cancer. But continued research revealed that the side effects of daily aspirin is more damaging than previously thought. . This prompted the United States Preventive Services Task Force (USPSTF) to issue new guidelines for taking aspirin daily, and those guidelines suggest that aspirin may have more risks than benefits for some people – perhaps you.
This is big news considering that an estimated 50 million people take aspirin on a regular basis for heart attack and stroke prevention. If you’re one of them or are considering aspirin therapy, I suggest you continue reading to learn about these new guidelines and to find out if aspirin therapy is right for you.
What are the New Aspirin Guidelines?
Aspirin can irritate your stomach and cause internal bleeding. This bleeding can be serious, raising the risk of ulcers and hemorrhagic strokes. These strokes are not the most common but they are very powerful and damaging – if not fatal.
The USPSTF’s new guidelines aims to mitigate the risks of aspirin on an individual basis. Essentially, the USPSTF now suggests a more patient-specific approach to aspirin therapy in which you weigh your risks and benefits against each other. Those risks and benefits vary because some people are more susceptible to heart disease that aspirin aims to prevent, but some people are more susceptible to the internal bleeding that aspirin can cause.
Specifically, men have a greater risk for internal bleeding. But for men and women, this risk increases as they age.
To weigh these risks and benefits, the USPSTF used a calculator that determines a person’s 10-year risk for developing Atherosclerotic Cardiovascular Disease (ASCVD). The calculator allows doctors to punch in specific data determining your risk for ASCVD – age, gender, race, blood pressure, cholesterol levels, and other factors such as whether you smoke or have diabetes.
For example, men have a greater risk of having a heart attack than women. Women are more likely to die or suffer a major disability from a stroke than men. And African-Americans are more prone to high blood pressure, which makes them more likely than other ethnicities to develop heart disease.
As a reference point, a 7.5% risk of ASCVD is considered “elevated.”
Using these calculated risks for ASCVD, the USPSTF issued the following recommendations:
- Patients under the age of 50: No recommendations because researchers are unable to evaluate the benefits versus the risks.
- Patients ages 50 to 59: A daily low-dose aspirin (81 mg) is recommended if you have a 10% or greater ASCVD risk and if you don’t have any other factors that would elevate your risk of bleeding. This group is also most likely to benefit from colorectal cancer prevention. Benefits are maximized if you commit to taking aspirin daily and if your life expectancy is at least 10 more years.
- Patients ages 60 to 69: The decision to initiate daily low-dose aspirin therapy should be evaluated on an individual basis if you have a 10% or greater ASCVD risk. You are likely to benefit from daily low-dose aspirin if you aren’t at increased risk for bleeding and have a life expectancy of at least 10 more years, but that benefit won’t have as much of an impact as it does for people ages 50 to 59. The same is true about reducing your risk for colorectal cancer. Bottom line, the pros may not outweigh the cons.
- Patients over the age of 70: No recommendations because researchers are unable to evaluate the benefits versus the risks.
While the USPSTF’s research and recommendations were an improvement, there are a few other factors that can drastically affect how your body reacts to aspirin therapy.
For example, regular use of aspirin and ibuprofen or another nonsteroidal anti-inflammatory drugs (NSAIDs) increases the risk of gastrointestinal bleeding by fourfold. Also, use of an anticoagulant drug such as warfarin also increases the risk for stroke or serious bleeding.
Should You Take Aspirin to Prevent Heart Attack or Stroke?
Ultimately, this question should be answered by your doctor – not me. And that’s the thinking behind the USPSTF’s new guidelines.
The individual-based recommendations encourage more patients to ask this question and force doctors to think more carefully when answering it. It promotes dialogue between doctors and patients, especially concerning side effects, medications, and how other medical conditions interact with aspirin therapy.
I believe this will ultimately result in better care and patient satisfaction.
Give Your Aspirin Therapy a Big High Five
If you are considering aspirin therapy, the good news is that it can lower your risk of having a first heart attack or stroke by 25%. That’s an impressive number but it also shows that aspirin alone cannot protect you.
You can give your aspirin therapy a big boost by committing to five major principals of healthy living:
- Don’t smoke
- Maintain a healthy weight
- Drink alcohol only in moderation
- Eat a healthy diet
- Exercise daily
Yes, I realize that I recommend these in nearly every article I write but the value of them is immeasurable. Actually, strike that. It’s very measurable.
Committing to them lowers the risk of having a heart attack or stroke by 50% to 80%. And that isn’t even factoring the dozens of other ways they can make you healthier and happier – improved mood, better sleep, more energy, controlled blood sugar, and much more!
Keys to Lowering Risk: Commitment and Consultation
The USPSTF’s new guidelines become even more important when seen in the context of our nation’s overall health. Cardiovascular disease is still the top cause of death in our country, accounting for 30% of all deaths…cancer accounts for 25%.
Aspirin can help prevent you or a loved one from becoming one of these statistics but there are varying risks and benefits depending on a number of factors. But there is no doubt about the power of a healthy lifestyle regardless of your age, sex, and race, and more. Commitment is key, as is consultation with your doctor.
- “Final Recommendation Statement – Aspirin Use to Prevent Cardiovascular Disease and Colorectal Cancer: Preventive Medication.” U.S. Preventive Services Task Force. Published April 12, 2016.
- “New Guidelines Refine Aspirin Prescription.” Harvard Health Letter. Published June 2009.
- “Understanding Your Risks to Prevent a Heart Attack.” American Heart Association. Updated January 11, 2018.