Posted on 01/31/2025 5:40:55 AM PST by Red Badger
Cardiovascular disease is the number one cause of death in the United States, at a cost of about 700,000 lives per year. For decades, and as recently as 2022, doctors recommended that all healthy older people take a low dose (81 milligrams) of aspirin daily for primary prevention of heart disease and strokes.
When new research challenged the value of the benefits of prophylactic aspirin as a blanket recommendation for all older, healthier adults, the American College of Cardiology (ACC), the American Heart Association (AHA), and the United States Preventive Services Task Force (USPSTF) amended their recommendations. They advise against daily aspirin for people with no history of heart disease, due to potentially dangerous side effects.
Despite this change in recommendations, research indicates that about 29 million Americans with no previous heart disease are still taking aspirin for prevention. About 6.6 million do so without a physician’s recommendation.
So, what’s right for you when it comes to aspirin?
There is no simple answer, according to Yale cardiologist Michael Nanna, MD. In Yale Medical News he explains, “It depends on a variety of factors, including a person’s age, risk factors and individual medical history.”
Cardiovascular disease defined
Cardiovascular disease (CVD) is the term for diseases of the heart and blood vessels – a wide range of conditions and events:
Coronary artery disease – Narrowing or blockage of the blood vessels that feed oxygen to the heart muscle
Arrhythmias – Irregular heartbeats
Hypertension – High blood pressure
Peripheral artery disease – Narrowing or blockage of the blood vessels supplying oxygen to organs other than the heart and to the limbs
Heart attack – Complete blockage of a coronary artery, preventing blood from reaching heart muscle
Heart failure – The heart’s pumping is insufficient to meet the body’s needs for oxygen.
Stroke – Blood supply to the brain is reduced or blocked, depriving the brain of oxygen. These can be caused by a blocked blood vessel or bursting of a blood vessel.
Risk factors for these conditions include:
High cholesterol
Smoking
Diabetes
Obesity
Poor diet, especially high fat
Physical inactivity
Excessive alcohol use
Why physicians previously recommended aspirin therapy
Aspirin is one of a group of drugs called nonsteroidal anti-inflammatory drugs. You’re familiar with the group; it includes ibuprofen (Motrin) and naprosyn (Aleve). Among its numerous uses, aspirin is a blood thinner. It prevents platelets (small blood components) from forming clots.
Blood clots are the leading cause of heart attacks and strokes. For that reason, doctors have, for decades, recommended that adults in their 50s and older take a low-dose (81 milligrams) aspirin daily to prevent the disorders listed above. This is primary prevention—a disease has not yet occurred. The term secondary prevention applies when there is a history of disease in an individual and the goal is preventing future events.
Why change the guidelines?
The guidelines changed because the risks of taking low-dose aspirin outweighed the benefits. Because it’s a blood thinner, aspirin can increase the risk of bleeding in the gastrointestinal (GI) tract or bleeding into the brain, which is a type of stroke. Older adults are already at increased risk for GI bleeding, bleeding into the brain as a type of stroke, and head trauma causing bleeding into the brain. Aspirin heightens all these risks.
In 2018, three important studies showed the benefits and risks of preventing CVD with aspirin. These were the ASPREE, ASCEND, and ARRIVE studies. Two of the studies showed no benefit but increased risk of bleeding. One study showed a slight reduction in CVD risk, but also at the expense of increased bleeding risk. The bleeding risks outweighed the potential benefits.
These studies were done as primary prevention. None of the participants had already experienced CVD. For patients who had already experienced a cardiac event or undergone bypass surgery, there is “strong evidence” that aspirin helps prevent another event, according to the Journal of the America Medical Association (JAMA). It was determined that for aspirin as secondary prevention the benefits outweigh the risks.
Current guidelines for primary prevention
In response to the 2018 studies, both the AHA and the ACC changed their recommendations. They advise considering preventive aspirin for individuals at substantial risk for CVD, ages 40-70, but aspirin should be discontinued at age 70.
The USPSTF updated its guidelines to recommend against starting aspirin for primary prevention of CVD in patients 60 and older. They advise that patients ages 40 to 59 with a 10% or greater 10-year risk for occurrence of CVD should be considered on an individual basis.
Is low-dose aspirin right for you? Most healthy older adults should not take preventive aspirin. For those who have been taking daily low-dose aspirin it should probably be discontinued. It’s a decision to make with your healthcare provider, considering your medical condition, age, family history, and other risk factors.
“This is about personalized medicine and shared decision-making,” Dr. Nanna says. “I take it on a case-by-case basis, where I’m weighing what I can estimate as a patient’s risk for heart attack and stroke and deciding whether that risk threshold is high enough that it would outweigh the bleeding risk associated with starting low-dose aspirin. And then I present the patient with that information, and we make a decision together.”
Read the full recommendations from the AHA/ACC and USPSTF.
Ping!............
I believe aspirin would never be approved by the FDA if it was a “new drug”. I still take my 81 mg dose daily.
Me too.................
if it was a “new drug”..........it would cost $1000 a month...........
Poor diet, especially high fat
Hence the oldest treatment in the book:
“Take two aspirin and call me in the morning.”
It works all the time, under all circumstances. A person gets pain relief and the reassurance of receiving personal, professional care later. Relaxes, goes to sleep, and calls in the morning. Gets treated for something else if needed, and recovers from the other problem.
The person is having a real heart attack, but the aspirin lowers blood pressure, lowers pain levels, relaxes the patient, and the patient recovers overnight. Has no pain the morning. Doesn’t call in the morning.
The person is having a very real, very dangerous heart attack, but doesn’t recover. Dies a bit later that night with less pain. Doesn’t call in the morning.
👍
Are the latest guidelines more Deep State BS?
And I avoid them like the plague, GI issues. K2-7 COMPLEX keeps arteries open.
This “dietary cholesterol causes heart attacks” myth needs to be thrown out.
Ancel Keys was the original “Fauci”.
At this point, I would suspect that the REAL REASON they want people off aspirin is that it actually works.
“Poor diet, especially high fat. Stopped reading there.”
No kidding, almost stopped there myself. However, there may be something to that, but only if one combines the high fat with high carbs (in other words, eating normal ‘American’ food, since it takes effort to root out carbs from one’s diet).
You can eat a high-carb diet, or a high-fat diet. The human body will accept one or the other, it’s meant to be flexible in cases where meat or vegetables are not available.
We were built to be cavemen.
But eating both in high amounts is what gets people into trouble.
Neither would Coffee.
I believe that eating grains happened very recently in human history. Dairy too (goat first)
——aspirin is a blood thinner——
As one who took a 325 mg aspirin tablet for years when I was both diabetic and very heavy, I was free of lots of symptoms that were experienced by my peers.
As I lost weight I became susceptable to bruises on my hands and arms.
I was advised the best course was to cease the aspirin altogether. It took literally months for the bruising to cease. I still get blue marks from various small wacks but no blue arms from just working.
I still carry and recommend carrying an Altoid box with two aspirin to be chewed if I feel a stroke or coronary coming on
The idea was that people ate for winter, because during the winter food was more scarce. That is the purpose of body fat in the first place, to provide energy when food is scarce. Bears eat nuts and berries to fatten up so they can hibernate during the winter, when those aren’t available.
But that’s not an issue anymore. Now all kinds of foods are available 24/7 365 days a year. And so there is no longer the need to fatten up by eating carbs.
When I get injured, aspirin is my go to med. It’s the only NSAID I can take for extended periods that doesn’t cause my blood pressure to increase.
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