New recommendations on the use of low-dose aspirin to prevent a first heart attack or stroke say the blood thinner’s risks may outweigh its benefits, breaking from more than 30 years of widely accepted medical guidance.
Current evidence highlighting the risks of internal bleeding associated with aspirin use prompted the U.S. Preventive Services Task Force to revise their 2016 guidelines. The final recommendations, based on analysis of randomized clinical trials involving thousands of participants, were published Tuesday.
Heart disease is the leading cause of mortality in the U.S., accounting for 1 in 4 deaths, according for the Centers for Disease Control and Prevention. Aspirin, which can be easily purchased over-the-counter, has long been considered an accessible prevention strategy for those worried about their heart health because it works to reduce blood clotting. Untreated blood clots can lead to heart attack or stroke.
Those 60 and older who are not already taking aspirin as a blood thinner shouldn’t start taking it as a preventative measure against heart attack or stroke, according to the updated guidance. People ages 40 to 59 who are concerned about cardiovascular disease, should only use low-dose aspirin in consultation with a health care professional who can help weigh the individual benefits and risks.
“This is an important recommendation because more than 600,000 people will have a first heart attack this year and another 600,000 will have a first stroke,” said John Wong, a professor at the Tufts University School of Medicine and a member of the task force.
The task force’s updated guidelines are a significant change from 2016, when it recommended initiating low-dose aspirin to most people between 50 and 60 who were not at high-risk for bleeding and on an individual basis to those above 60.
Aspirin’s blood-thinning properties are a risk for those with other health conditions that may predispose them to bleeding. And for those people, the task force’s review of evidence from 14 randomized clinical trials found that aspirin was associated with increased risk of gastrointestinal bleeding and intracranial bleeding.
Risk of internal bleeding, with or without aspirin, increases with age. The task force’s review notes that bleeding risks are also higher for men, people with diabetes and those with a history of gastrointestinal issues. Liver disease, smoking, and elevated blood pressure also elevate the risk. Certain medications, including nonsteroidal anti-inflammatory drugs, steroids, and other anticoagulants are also risk factors.
For people 40 to 59, who are not at risk of bleeding and are concerned about having a heart attack or stroke, there may be some net benefit to taking low dose aspirin for prevention, the review found. But before initiating the medication, people should talk to a doctor first.
Other preventive health measures, such as regular exercise and healthy eating habits, are highly effective at improving heart and general health. Wong said that quitting smoking, treating hypertension and monitoring blood pressure are also important tools to help prevent a heart attack or stroke.
Those already taking aspirin, or those who have already had a heart attack or stroke, should make all decisions in coordination with a health care professional, Wong said.