If you’re at low risk for heart disease and are taking aspirin daily, new research has led to new guidelines from the U.S. Preventive Services Task Force (USPSTF) that may make you and your doctor reconsider.
“Daily aspirin is still recommended for adults with high risk of blood clots, or those who have had a heart attack, stroke, or an arterial stent. But using aspirin every day to prevent a heart attack or stroke for anyone who does not have established vascular disease is now no longer a blanket recommendation,” says Michael Weinrauch, MD, chair of cardiology at Atlantic Health System’s Overlook Medical Center.
Dr. Weinrauch outlines the newest recommendations from USPSTF. For people over the age of 60, use of daily low-dose aspirin to prevent heart disease is discouraged. For people ages 40 to 59 who have higher than a 10% ten-year risk of a cardiovascular event, stroke or heart attack and a low bleeding risk, use of daily low-dose aspirin is recommended.
Talk With Your Doctor About Your Risk Level
Aspirin reduces blood clotting — the primary cause of stroke and heart attack. But it also increases bleeding. So how do you know what’s best for you? Adults at low risk for heart and vascular disease may decide that potential bleeding risk outweighs clotting risk and will choose not to take daily aspirin. Or adults with higher clotting risk may favor aspirin because it may outweigh their bleeding risk.
For example, a 63-year-old patient who has never had a heart attack, stroke or stent, but who has a very elevated calcium score higher than 400 may opt to take an aspirin if they have a low bleeding risk.
“This is a very personalized decision and the older you are, the greater your risk of bleeding,” says Dr. Weinrauch. “The USPSTF guidelines are not a strict black and white decision but rather a recommendation to help guide a discussion with your doctor about potential risks and benefits. Shared decision-making is the best way to decide if daily aspirin is right for you.”
Possible Side Effects from Long-Term Aspirin Use
Aspirin is a blood thinner that keeps the platelets in the bloodstream from sticking together. This allows for good blood flow through the arteries of the heart and brain, reducing the risk of heart attack, stroke, and coronary artery disease. But regular aspirin use can cause some other unwanted side effects:
- anemia (low iron)
- reduced red blood cell count
- stomach ulcers
- bleeding in the brain or stomach
- excess bruising
Dr. Weinrauch cautions that combining low-dose aspirin with specific types of prescription blood thinners can increase a person’s risk of major bleeding. Also, if you’re pregnant, have high blood pressure, a bleeding disorder, asthma, stomach ulcers or liver problems or kidney disease, you should not be taking aspirin regularly.
“Aspirin is still an important medication if you’ve had a heart attack or stroke, and we want you to stay on low-dose aspirin every day because the benefits outweigh the potential risks,” says Dr. Weinrauch. He also stresses that patients should never stop taking any prescribed or over-the-counter blood-thinning medications without talking to their doctor first.
Personalized Decision-Making Is Key
“The idea behind these new guidelines is if you’re at risk for heart disease, aspirin can help prevent more complications from developing from your existing disease,” says Dr. Weinrauch. “If you don’t have heart disease but you’re at high risk for developing it, aspirin can help prevent a cardiovascular event. It’s a very individualized decision.”
Be Proactive About Your Health
To stay safe and healthy, it's good to have a primary care provider who knows and understands your health history and wellness goals.