Aspirin may not be the easy, cheap, daily wonder drug that doctors once thought it might be: New research has led medical experts to rethink and caution against the low-dose regimen followed by tens of millions of patients in hopes of preventing heart and colon conditions.
Those popping aspirin as a safeguard should talk to their doctors, pronto, about continuing to do so — and they should not suddenly quit, on their own. For the middle-aged and mostly healthy, who once might have been routinely advised to do so, doctors should refrain from recommending they take regular low doses, an elite expert advisory panel says.
The U.S. Preventive Services Task Force (USPSTF), independent and respect advisors on medical tests and protective procedures, says that evidence has built that aspirin’s risks of causing problematic internal bleeding (in the brain and gastric tract) exceeds its benefits in thinning the blood and reducing heart and colon conditions. As the New York Times reported:
“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 newspaper reported that experts gradually have shifted in their support for aspirin:
“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 That advice differs from the task force’s new draft guidance for a cutoff at age 60.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.’”
The earlier enthusiasm for aspirin dated to the 1980s and 1990s, when, media reports say, studies were conducted mostly on older men and doctors were not as focused as they are now on also controlling with drugs patients’ problems with high blood pressure and high cholesterol. Those medications also have become inexpensive, widely available, and have proved largely effective in controlling key conditions connected with heart conditions.
Authorities reexamined the information on colon cancer — a disease that experts worry is showing up with increasing frequency in younger patients — and decided they needed more data to make the case for aspirin’s protective benefits versus its potential harms.
Experts said their revisiting aspirin’s use was a needed and common-sense step, especially given the evolution in heart and colon cancer diagnosis and treatment, as well as to discourage a popular misconception that buying and taking an off-the-shelf medication without expert medical consultation is a wise step.
The Washington Post reported that the aspirin recommendation is important, quoting Chien-Wen Tseng, a physician, preventive task force member, and a professor in the Department of Family Medicine and Community Health at the University of Hawai’i John A. Burns School of Medicine:
“The change in recommendations could affect millions of people nationwide. Heart disease is the leading cause of death in the United States, killing roughly 659,000 people each year, according to the Centers for Disease Control and Prevention. Strokes rank fifth, with about 150,000 fatalities yearly. ‘Every year, an estimated 1.2 million people experience a first heart attack or stroke, so we’re talking about something pretty serious,’ Tseng said.”
The USPSTF will accept comments for a few weeks on its recommendation on aspirin before finalizing its advisory, a process that typically includes publication of its rationales and supporting data in medical journals. The task force’s guidance is well-respected, helps to shape medical practice, and plays a big role in tests and treatments that health insurers cover.
In 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.