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Don't Start Aspirin Regimen to Prevent Heart Attack, Stroke After Turning 60

Health experts warn bleeding risks can outweigh cardiovascular benefits

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Adults who are 60 and older should not start taking aspirin to lower their risk of a first heart attack or stroke, according to new draft recommendations posted by the U.S. Preventive Services Task Force (USPSTF) on Oct. 12. And people ages 40 to 59 who are at higher risk for cardiovascular disease — but don’t have a history of it should talk to a health care provider before starting an aspirin regimen, the group of medical experts say.

The proposed guidance is based on new evidence that suggests the potential harms of taking aspirin can outweigh the benefits. Daily aspirin use has been shown to lower the chance of having a first heart attack or stroke, both of which are leading causes of death in the U.S. But the over-the-counter medication, which thins the blood and prevents clots from forming, can also lead to life-threatening bleeding in the stomach, intestines and brain — a risk that increases with age.

“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,” UPTSTF member Chien-Wen Tseng, M.D., a professor at the University of Hawaii John A. Burns School of Medicine, said in a statement. “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.”

The new guidance, which will be finalized after the public comment window closes on Nov. 8, pivots from previous recommendations issued in 2016, which suggest that people ages 50 to 59 with a risk of cardiovascular disease that is 10 percent or greater in the next decade and a low risk for bleeding take a daily low-dose aspirin (100 milligrams a day or less) to reduce the likelihood of suffering a heart attack or stroke. The decision to start taking aspirin for preventive reasons should be “an individual one” for adults ages 60 to 69 who are at risk for cardiovascular disease, the 2016 recommendations say.

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Currently, the American Heart Association and the American College of Cardiology do not recommend aspirin use for the prevention of heart attack and stroke in the general population — just for some people between the ages of 40 and 70 who have never had a heart attack or stroke but have an increased risk for cardiovascular disease and a low risk for bleeding. Adults 70 and up should not take the medication to prevent a first heart attack or stroke, the groups say.

Even still, aspirin use for the primary prevention of cardiovascular-related incidents is common in the U.S., “and is often self-initiated rather than recommended by a physician,” the latest USPSTF report states. A 2017 National Health Interview Survey (NHIS) found that 23.4 percent of adults age 40 or older and without cardiovascular disease took aspirin for primary prevention; among adults 60-69 years, 34.7 percent reported aspirin use.

According to the American Heart Association, nearly half of American adults have some type of cardiovascular disease — a catch-all term for conditions that affect the heart and blood vessels. High blood pressure is the leading risk factor for cardiovascular disease; diabetes, obesity and age can also increase risk.

If you are already taking aspirin and have questions about continuing, talk to your health care provider, the USPSTF says.

Rachel Nania writes about health care and health policy for AARP. Previously she was a reporter and editor for WTOP Radio in Washington, D.C. A recipient of a Gracie Award and a regional Edward R. Murrow Award, she also participated in a dementia fellowship with the National Press Foundation.

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