A major reversal on long-held view of low-dose aspirin’s heart benefits

aspirinme-225x300Aspirin has gotten its crown knocked askew as a cheap, effective low-dose heart problem preventer for older Americans.

That’s because the U.S. Preventive Services Task Force has weighed the evidence, heard the comments, and recommended against patients 60 and older taking the common drug to avert cardiovascular diseases. The experts gave this purportedly protective step a “D” grade.

The USPSTF is an elite, independent, and influential group of experts who advise the federal government, insurers, and clinicians about the safety and effectiveness of medical tests and procedures based on rigorous consideration of their merits.

The panel said taking low-dose aspirin daily put older patients at higher risk of bleeding and this threat outweighs potential heart benefits of the drug.

In patients who are ages 40 to 59 and whose doctors deem to have a 10% or higher risk of cardiovascular disease, the USPSTF recommendation would be to leave it to individual patients and their doctors to decide about taking aspirin regularly. The panel rated aspirin use of these individuals as a “C.”

This advisory represents a sizable shift in clinical thinking, NPR reported:

“’What we found is that compared to older studies, aspirin appears to have less benefit from cardiovascular disease,’ Dr. John Wong, a physician at Tufts Medical Center and a member of the task force, told NPR in November. ‘And there’s an increasing risk of bleeding as people age,’ he says. Whether you choose to take aspirin depends on your cardiovascular risk and should be decided with your doctor, Wong says. And while many people take aspirin safely, it can cause bleeding in the stomach, intestines and brain which can be life-threatening.

“There are some important nuances of the guidelines. They don’t apply to people who’ve already had a heart attack or stroke. And they don’t tell adults who are currently taking daily aspirin to stop taking it. However, the task force does caution that because of increased bleeding risk with age, patients may need to consider stopping daily aspirin use around age 75. Cardiovascular disease is the leading cause of mortality in the U.S., accounting for more than 1 in 4 deaths.

“Each year about 600,000 people in the U.S. have a first heart attack and about 600 thousand people experience a first stroke. The science has changed since the influential medical panel put out its last guidance on taking aspirin to prevent cardiovascular disease in 2016. Dr. Salim Virani, a cardiologist at Baylor College of Medicine, says newer studies are not finding as much of a benefit, in part because people are taking drugs like statins. ‘Aspirin’s benefit has become marginal because we have these other therapies that reduce the risk of heart attacks or strokes, but the bleeding risk associated with aspirin therapy has persisted,’ he told NPR in November.”

Patients should not just stop taking aspirin and they should talk with their doctors, experts say. By the way, as part of the conversation, this would be the perfect time to get your doc to review all the drugs prescribed for you to see if others should be dropped, too. Or maybe there’s a cheaper alternative for some? After your doctor goes over all your medications, if you need to fill any, find a good time to talk to your pharmacist, too, about everything you’re taking — including supplements, herbs, whatever …

n my practice, I see not only the harms that patients suffer while seeking medical services but also their struggles to access and afford safe, efficient, and excellent health care. This has become an ordeal due to the skyrocketing cost, complexity, and uncertainty of medical therapies and prescription medications, too many of which turn out to be dangerous drugs.

It may be distressing to some patients that respected medical authorities reverse themselves about what becomes conventional wisdom about our care. But our knowledge about best practices can and must evolve, and it is a good thing for experts like those on the USPSTF to revisit and revise medical guidelines and recommendations when the data change.

This situation can serve as a reminder, too, that the public should not put excess faith in pills to deal with their health conditions. Preventive steps often can be better and cheaper than medical treatments, so, besides gulping aspirin, let’s hope that people are protecting their hearts and digestive systems with good exercise, healthful eating, restful sleep, appropriate consumption of alcohol and other intoxicating substances — and more. We have much work to reduce the toll that heart disease and colon cancer inflict on us.

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