In 2016, the U.S. Preventive Services Task Force recommended adults ages 50-59 who are at high risk for cardiovascular disease take a low-dose aspirin daily to prevent heart attacks and strokes. The task force -- an independent panel of national experts in disease prevention and evidence-based medicine – also recommended adults ages 60-69 who are at high risk for cardiovascular disease talk to their doctors about whether they should start a daily aspirin regimen.
Now, the task force has issued new draft recommendations that change the way doctors and patients should think about who should take aspirin. As the guidelines inch closer to becoming final, I want patients to know that nothing in the recommendations should make them start or stop taking a daily baby aspirin without first talking to their physician. And if you are taking daily baby aspirin because you previously had a heart attack, stroke, bypass surgery or a cardiac stent, do not stop taking the aspirin.
Here is some helpful information about heart disease, risk factors and the draft recommendations from the task force.
How prevalent is heart disease? Strokes?
Coronary artery disease is the most common type of heart disease in the United States, with approximately 18.2 million adults ages 20 and older with the condition, according to the U.S. Centers for Disease Control and Prevention. Heart disease continues to be the leading cause of fatalities in the United States, causing about 1 in 4 deaths, according to the CDC.
Approximately 800,000 people a year have a stroke in the United States. Strike is the fifth-leading cause of death.
What has been the role of aspirin in preventing heart attacks and strokes?
Heart attacks are usually the result of coronary artery disease. Coronary artery disease is caused by cholesterol plaques in the arteries, meaning that plaque – made up of fatty substance, cholesterol, calcium — has built up inside the arteries. The plaque is covered by a fibrous cap. If the fibrous cap comes off, a blood clot forms around the plaque. This blood clot may block the flow of blood through the arteries, leading to a heart attack.
A stroke occurs when a blood clot blocks a blood vessel in the brain.
Baby aspirin is a blood thinner that can prevent blood clots by preventing platelets from clumping together. Because aspirin prevents blood clots from forming, it can help prevent heart attack or stroke.
What is the U.S. Preventive Services Task Force changing?
The panel issued draft guidelines that recommend:
- Adults ages 40-59 who are at high risk for heart disease – with no previous personal history of heart disease – should talk to their doctor about whether they should take baby aspirin as a preventive measure. This is the first time the task force has recommended that adults starting in their 40s, rather than in their 50s, talk to their doctor about taking aspirin for heart health. And this is a marked shift from the 2016 recommendation that adults ages 50-59 who are at high risk for cardiovascular disease take a low-dose aspirin daily to prevent heart attacks and strokes. The panel said: "Evidence indicates that the net benefit of aspirin use in this group is small. Persons who are not at increased risk for bleeding and are willing to take low-dose aspirin daily are more likely to benefit."
- Adults ages 60 and older should not take aspirin to prevent heart disease and stroke. The drawbacks outweigh the benefits. This is a shift from the 2016 recommendation that advised high-risk adults ages 60-69 discuss the pros and cons with their physicians.
The recommendations only apply to people who are at high risk for cardiovascular disease, have no history of cardiovascular disease and are not already taking daily aspirin.
Who is considered high-risk for a heart attack or stroke?
Risk factors for heart attack or stroke include:
- A parent or sibling who had a heart attack or stroke before age 50, or multiple extended family members with history of heart attack or stroke before age 50
- Personal medical conditions, including diabetes, high cholesterol, high blood pressure and kidney disease
- Being obese, having a history of smoking and living a sedentary lifestyle – fewer than 2,500 steps per day – can also elevate a patient's risk of cardiovascular disease.
The more risk factors a patient has, the greater the risk of suffering a heart attack or stroke.
Why are the recommendations changing?
The task force looked at data related to the bleeding harms associated with aspirin. Though aspirin is known to be a blood thinner and prevent blood clots, it can cause gastrointestinal bleeding, primarily in the stomach. Aspirin can wear away at the stomach lining, exposing the blood vessels, which, in turn, can lead to the blood vessels rupturing and bleeding. Also, aspirin has been rarely connected to bleeding in the brain (intercranial hemorrhage).
The chance of bleeding increases with age and can be life threatening.
When weighing the risk of these types of bleeds against the benefits of preventing heart attacks and stroke, the task force decided to recommend against adults in their 60s taking aspirin to prevent heart disease and strokes, and decided that patients in their 40s and 50s should discuss the pros and cons with their doctors. It's important to understand, though, that in studies, patients who took baby aspirin did, indeed, have a lower risk of heart attack or stroke – but they also had a higher risk of bleeding events. The recommendations are an outcome of balancing the risks and benefits.
What if I've been taking daily baby aspirin? Should I stop?
If you are among the millions of Americans who are taking a low-dose aspirin (between 81 milligrams to 100 milligrams) daily to prevent heart attack or stroke, do not stop without talking to your doctor. With your doctor, you can decide whether the advantages of continuing to take the aspirin outweigh the disadvantages in your particular case. Your physician will consider your individual risk of heart attack, stroke and internal bleeding.
Important note: If you are taking daily baby aspirin because you previously had a heart attack, stroke, bypass surgery or a cardiac stent, do not stop. The advantages of continuing to take the aspirin to prevent another heart attack or stroke are considered to outweigh any drawbacks.
What can I do to prevent heart disease?
There are many steps patients can take to improve their heart health. Focus on a heart-healthy diet, full of whole grains, lean proteins, fatty fish, fruits and vegetables. Foods should be low in sodium and sugar. Processed foods should be avoided.
Know your numbers. Be familiar with your blood pressure levels, your cholesterol levels and your weight.
Embrace exercise. I encourage everyone to resolve in 2022 to get more active. So many of us let physical activity slide during the pandemic. Now is the time to pledge to start or restart an exercise routine. Every little bit helps. If you've been exercising a little, kick it up a notch. If you've being doing nothing, doing even a few minutes a day will pay dividends.
If you need help starting an exercise routine or figuring out ways to incorporate more healthy foods into your diet, reach out to your physician for guidance. Being heart healthy is one of the best presents you can give yourself in 2022.