For years it’s been recommended that older adults take an aspirin daily to help prevent a heart attack or stroke, but the U.S. Preventive Services Task Force has reversed its stance and no longer advises people who are aged 60 and over to take an aspirin as a preventative measure. “The latest evidence is clear: starting a daily aspirin regimen in people who are 60 or older to prevent a first heart attack or stroke is not recommended,” stated Task Force member Chien-Wen Tseng, M.D., M.P.H., M.S.E.E in the updated guidelines. “However, this Task Force recommendation is not for people already taking aspirin for a previous heart attack or stroke; they should continue to do so unless told otherwise by their clinician.” In light of this new information, Eat This, Not That! Health talked to medical experts about the recent findings. Read the 6 tips below to find out what they’re saying about taking aspirin and to ensure your health and the health of others, don’t miss these Sure Signs You’ve Already Had COVID.
New evidence reveals that taking a daily aspirin “may help prevent heart attacks and strokes in some people, but it can also cause potentially serious harms, such as internal bleeding,” Task Force member John Wong, M.D., stated in the updated guidelines. Cardiologist Dr. Sam Kalioundji MD FACC/Kalheart says he does “agree with guidelines although guidelines are exactly what they say they are—they are to guide—a detailed look at every individual patient and a discussion with the doctor is essential to make the right decision. Multiple factors need to be assessed – risk/benefit analysis—mainly the benefit of primary prevention from heart disease and stroke versus the risk of bleeding. The risk of bleeding is the biggest risk and area of concern for patients with no risk factors and no history of heart disease or stroke…The risk of bleeding especially from the gastrointestinal tract is of biggest concern for those over the age of 60 years old.”
Dr. Terrell Smith MD, MPH, Founding Physician of Spora Health, a telehealth platform offering primary care for people of color, says, “Black patients are unfortunately more likely to present with obesity, high blood pressure, high cholesterol, diabetes and several other diseases, often linked to poorer socioeconomic status and inability to easily access healthcare, that all contribute to an increased risk of cardiovascular disease. If the patient has had a history of a stroke or heart attack then we still recommend they follow the guidelines and take an aspirin as advised by their primary provider. But, in general, we do approach it on a case by case basis to weigh the risks for the BIPOC population, given the potential side effects of taking aspirin.”
While aspirin was considered a go-to preventive measure against heart disease, there are several others people should consider according to Dr. Guy Mintz, director of cardiovascular health and lipidology at the Sandra Bass Heart Hospital in Manhasset, N.Y. He told U.S. News, “lowering cholesterol, controlling diabetes, weight loss and exercise and quitting smoking are essential. But advances in preventive care make aspirin unnecessary. He added, “Now, 30 years later, we have more tools in primary prevention of a heart attack and extensive data to support our approach,” he said, adding: “With all of these advances the need for aspirin in all patients has been negated.”
In addition to the risks mentioned above, people should also be aware of an allergy to aspirin explains Dr. Terrell Smith MD, MPH, Founding Physician of Spora Health, a telehealth platform offering primary care for people of color, “When it comes to advising on the risks, there’s a small portion of the population that has an allergy to aspirin, so I always let my patients know about that. The major side effect we worry about is gastrointestinal bleeding so that’s something we are always very vocal about explaining before advising patients to take aspirin.” He adds, “I agree with the task force because it’s made up of a group of very accomplished physicians, researchers, and public health elect that have many years working within preventative medicine and associated research. The fact that they are constantly updating their recommendations to do what is safest for patients is also very reassuring.”
It’s common for patients with COVID-19 to take aspirin to help prevent blood clotting and according to cardiologist Dr. James R. Higgins, MD, people should consult their doctor first before doing so. He explains, “In general we have seen an increase in the incidence of heart attack as well as stroke in patients presenting with both classically symptomatic COVID-19 infection as well as those with little to no symptoms. These events are thought to be mediated through a mechanism in which covid infection brings about a hypercoagulable state in the blood of the infected person. This in turn leads to formation of thrombosis or clotting within the patients arteries supplying both cerebral as well as coronary circulations, and thus subsequent strokes and heart attacks. These events are potentially prevented through use of medications that help to prevent this hypercoagulable, or “thickening” state of the blood, such as true anticoagulants(blood thinners) or the most simple, antiplatelet medications , such as aspirin.”
He adds, “Unfortunately, it is difficult to predict which person will suffer from these complications, after being infected with COVID, and thus difficult to decide for whom therapy is best suited. Now, in light of new recommendations by the United States Preventive Services Task Force, that the daily use of aspirin in some groups may pose a larger risk for adverse events (hemorrhagic stroke or gastrointestinal bleeding) than previously thought it should not be just a blanket recommendation or thought for all those infected to start taking daily aspirin to prevent adverse outcomes. Instead, we should have learned that aspirin is not to be taken lightly, and that the best advice is to consult a physician prior to deciding upon such therapy for oneself. Each patient should be treated on a case by case basis.”
If you’re wondering if you should stop taking aspirin as a result of the new guidelines, cardiologist Dr. James R. Higgins, MD, says, “People should not read into the new recommendations by the Task Force as being an end to the use of aspirin in all groups for prevention of cardiovascular events. These new recommendations are for primary prevention (those individuals without a prior h/o cad, heart attack, previous stents, bypass surgery, stroke) of cardiovascular events (MI, CVA) and thus do not apply to individuals with previously known disease (cad, MI, CVA) and may even represent an altogether different pathological mechanism than those for whom covid infection is the inciting event.” He adds, “Thus, who should still be considered for continuation or even initiation of regular aspirin therapy for prevention of cardiovascular events: 1. You are between the ages of 40-70 and at high risk for CV events and at overall low risk of bleeding. 2. You have a prior history of heart attack, stroke, prior stents, bypass surgery. And who should either stop using regular aspirin therapy or no longer be considered for initiation: 1. People under 40 and over 70 who are generally healthy 2. Have an increased risk of bleeding complications from taking aspirin due to a co-morbid condition or even use of another medication they take.” And to protect your life and the lives of others, don’t visit any of these 35 Places You’re Most Likely to Catch COVID.