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Wednesday, October 20, 2021

Advice shifting on aspirin use for preventing heart attacks

Author: LINDSEY TANNER | Associated Press

Seniors without heart disease should not take low doses of aspirin every day to prevent a first heart attack or stroke, the influential health leadership group said in preliminary updated guidelines released on Tuesday.

The risk of bleeding for adults ages 60 and older who have not had a heart attack or stroke outweighs any potential benefits from aspirin, the US Preventive Services Task Force said in its draft guidance.

For the first time, the group said there might be little benefit for adults in their 40s who are not at risk of bleeding. For those in their 50s, the commission softened the advice and noted that the evidence for benefits is less obvious.

These recommendations are for people with high blood pressure, high cholesterol levels, obesity, or other conditions that increase the likelihood of a heart attack or stroke. Regardless of age, adults should talk to their doctors about stopping or starting aspirin to make sure it’s the right choice for them, said task force member Dr. John Wong, primary care expert at Tufts Medical Center.

“Using aspirin can cause serious harm, and the risk increases with age,” he said.

If further developed, the guidelines for the elderly will depart from the recommendations of the group issued in 2016 to prevent the first heart attack and stroke, but will be in line with the later recommendations of other medical groups.

Doctors have long recommended low-dose daily aspirin for many patients who have had a heart attack or stroke. The leadership of the target group does not change this advice.

The task force previously stated that taking aspirin daily may also protect against colorectal cancer in some adults between the ages of 50 and 60, but the updated guidance says more evidence of any benefit is needed.

The guide was posted online to allow public comment by November 8th. The group will evaluate this contribution and then make a final decision.

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An independent panel of experts on disease prevention reviews medical research and the literature and periodically makes recommendations on measures to help keep Americans healthy. New studies and reanalysis of old studies have resulted in updated guidelines, Wong said.

Aspirin is best known as a pain reliever, but it also thins the blood, which makes blood clots less likely to form. But aspirin also has risks, even in low doses – mainly bleeding in the digestive tract or ulcers, which can be life-threatening.

Dr. Lauren Block, a research physician at the Feinstein Institute for Medical Research in Manhasset, NY, said the recommendations are important because so many adults take aspirin even if they have never had a heart attack or stroke.

Block, who is not part of the task force, recently switched one of her patients from aspirin to cholesterol-lowering statins because of the potential harm.

The patient, 70-year-old Richard Shrafel, has high blood pressure and is aware of the risk of a heart attack. Schrafel, president of a cardboard distribution company, said he never had any side effects from aspirin, but is serious about the new leadership.

Rita Seefeldt, 63, also has high blood pressure and took aspirin daily for about ten years, until her doctor advised her to stop two years ago.

“He said they changed their minds about this,” recalls a retired primary school teacher from Milwaukee. She said she understands that science is progressing.

Wong acknowledged that the return could leave some patients frustrated and perplexed as to why scientists can’t make a decision.

“This is a fair question,” he said. “What’s really important to know is that evidence changes over time.”

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Follow AP medical writer Lindsay Tanner on @LindseyTanner

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The Associated Press Department of Health and Science receives support from the Howard Hughes Medical Institute’s Department of Science Education. AP is solely responsible for all content.

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