Older adults without heart disease should not take daily low-dose aspirin to prevent a first heart attack or stroke, an influential health guideline group said in a preliminary updated advice released Tuesday.
The US Preventive Services Task Force said in its draft guidance that the bleeding risk for adults age 60 and older who have not had a heart attack or stroke outweighs any potential benefit from aspirin.
For the first time, the panel said there may be a small benefit for adults in their 40s who have no increased risk of bleeding. In their 50s, the panel softened the advice, saying the evidence for benefit is less clear.
The recommendations are for people with high blood pressure, high cholesterol, obesity or other conditions that increase the chance of heart attack or stroke. John Wong, a member of the primary care specialist task force at Tufts Medical Center, said that regardless of age, adults should talk to their doctors about stopping or starting aspirin to make sure it’s the right option for them. .
“Aspirin use can cause serious harm, and the risk increases with age,” he said.
If finalized, the advice for older adults would backfire on the panel’s recommendations issued in 2016 to help prevent earlier heart attacks and strokes, but would be in line with recent guidelines from other medical groups.
Doctors have long recommended daily low-dose aspirin for many patients who have already had a heart attack or stroke. Task force guidance does not change that advice.
The task force previously said that a daily aspirin may also protect against colorectal cancer for some adults in their 50s and 60s, but updated guidance says more evidence of any benefit is needed.
The guidance was posted online to allow public comments until 8 November. The group will evaluate that input and then make a final decision.
The independent panel of disease-prevention experts analyzes medical research and literature and provides periodic advice on measures to help keep Americans healthy. The new study and re-analysis of older research inspired updated advice, Wong said.
Aspirin is best known as a pain reliever, but it is also a blood thinner that can reduce the chances of blood clots. But aspirin also has risks, even at low doses—mainly bleeding in the digestive tract or ulcers, both of which can be life-threatening.
Lauren Block, an internist-researcher at the Feinstein Institute for Medical Research in Manhasset, New York, said the guidance is important because many adults take aspirin, even if they have never had a heart attack or stroke.
Block, who is not on the task force, recently switched one of his patients from aspirin to a cholesterol-lowering statin drug because of potential harm.
The patient, 70-year-old Richard Schrafel, has high blood pressure and is aware of his heart attack risks. Schrafel, president of the paperboard-distribution business, said he has never had any ill effects from aspirin, but he is taking the new guidance seriously.
Rita Seifeldt, 63, also has high blood pressure and took daily aspirin for almost a decade, until her doctor told her to stop two years ago.
“He said he changed his mind on that,” recalled the retired elementary school teacher from Milwaukee. She said she understands that science evolves.
Wong acknowledged that backtracking can frustrate some patients and wonder why scientists can’t make up their mind.
“It’s a fair question,” he said. “It’s really important to know that evidence changes over time.”
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