An Aspirin a Day May Not Keep All Doctors Away

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The American College of Cardiology and the American Heart Association no longer recommend aspirin therapy to lower risk of heart attack and stroke in healthy older adults, according to new guidelines. For decades, daily, low-dose aspirin was considered an easy way to help prevent heart attacks and other cardiovascular events — a practice now believed to cause more harm than good in people with no history of heart disease.

The new ACA and AHA guidelines are based on results of three recent studies and don’t apply to people who’ve been advised to take daily aspirin by their doctor. Studies published in 2018 and a comprehensive analysis completed early in 2019 indicate that the benefits of one-a-day aspirin therapy are offset by higher risks for gastrointestinal bleeding, hemorrhagic stroke, and stomach ulcers in those at low- or moderate-risk of heart disease. In particular, otherwise healthy people over 70 are strongly discouraged from taking low-dose aspirin due to an increased risk of these health issues.

Current guidelines from the U.S. Preventive Services Task Force recommend low-dose aspirin therapy for adults between 50 and 59 who have a higher than 10 percent risk of developing heart disease over the next 10 years.

But according to Dr. Erin Michos, associate director of preventive cardiology at the Ciccarone Center for the Prevention of Cardiovascular Disease at Johns Hopkins University School of Medicine and one of the authors of the updated American College of Cardiology/American Heart Association guidelines, these recommendations are based on outdated information. "Heart attack rates have gone down in more modern society with lower smoking rates and better treatment of blood pressure, better treatment of cholesterol," she said. "There probably was more of a role for aspirin back in the older trials, even though the bleeding issue has always been seen there."

Heart patients, including people with a history of heart attack or stroke and those who’ve had a coronary bypass or stent procedure, should continue to follow their doctor’s advice regarding daily aspirin.