The recommendations, which are not yet definitive, could affect tens of millions of adults who are at high risk for cardiovascular disease, which continues to be the leading cause of death in the United States, even during the Covid era. The Commission will accept public comments on its recommendations by November 8, although the draft guidelines are usually adopted.
Two years ago, the American College of Cardiology and the American Heart Association jointly narrowed their recommendations, indicating that aspirin should be given very selectively to people between the ages of 40 and 70 who have never had a heart attack or stroke. For aspirin, organizations say “mostly no, sometimes yes” for primary prevention purposes. This advice differs from the new draft target group guidance for the age limit of 60 years.
“When we looked at the literature, most of them showed that the net balance was unfavorable for most people – there was more bleeding than prevented heart attacks,” said Dr. Amit Hera, one of the authors of the medical group recommendations. “And it’s not a nosebleed, it could be a bleeding to the brain.”
And back in 2014, a FDA review concluded that aspirin should not be used for primary prevention, such as preventing a first heart attack or stroke, and noted the risks.
A target group that previously made a universal recommendation for high-risk adults in their 50s to take baby aspirin if their chances of a side effect were low is now suggesting that high-risk adults in their 40s and 50s talk to their doctors and made an individual decision about whether to start the daily regimen. (The group defined “high risk” as anyone who has a 10 percent or more risk of cardiovascular events over the next 10 years, according to the American College of Cardiology / American Heart Association calculators used to assess risk.)
When the task force released its latest set of guidelines in 2016, which endorsed the widespread use of aspirin for primary prevention in high-risk individuals and said the benefits outweighed the risks, some critics said the group had made a mistake. Dr. Stephen Nissen, chairman of the Cleveland Clinic of Cardiology, said at the time that he was concerned that more aspirin would do more harm than good. Gastroenterologists fear that patients taking aspirin will not be screened for colon cancer.
The first large national clinical trial to show that aspirin reduced the risk of heart attack was performed only by male doctors and was discontinued early after five years because the benefits were significant and significantly outweighed the risks. But that was in 1988 and medical practice has evolved since then, ”said Dr. Donald M. Lloyd-Jones, president of the American Heart Association.