October 20, 2021

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Aspirin use to prevent 1st heart attack or stroke should be curtailed, US panel says

Doctors should no longer routinely begin prescribing a daily regimen of low-dose aspirin to most people at high risk of a first heart attack or stroke, according to new draft guidelines by a U.S. panel of experts. 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 U.S. panel also plans to retreat from its 2016 recommendation to take baby aspirin for the prevention of colorectal cancer, guidance that was groundbreaking at the time. The panel said that more recent data had raised questions about the putative benefits for cancer, and that more research was needed.

On the use of low-dose or baby aspirin, the recommendation by the U.S. Preventive Services Task Force would apply to people younger than 60 who were at high risk of heart disease and for whom a new daily regimen of the mild analgesic might have been a tool to prevent a first heart attack or stroke. The proposed guidelines would not apply to those already taking aspirin or those who have already had a heart attack.

The U.S. task force also wants to strongly discourage anyone 60 and older from starting a low-dose aspirin regimen, citing concerns about the age-related heightened risk for life-threatening bleeding. 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.

The task force proposals follow years of changes in advice by several leading medical organizations and federal agencies, some of which had already recommended limiting the use of low-dose aspirin as a preventive tool against heart disease and stroke. 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.

“There’s no longer a blanket statement that everybody who’s at increased risk for heart disease, even though they never had a heart attack, should be on aspirin,” said Dr. Chien-Wen Tseng, a member of the national task force who is the research director of family medicine and community health at the University of Hawaii.

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