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.
You won't feel the one that 'gets' you. My mother-in-law's boyfriend just died of a stroke back in September. She said he said, "I feel dizzy," and dropped dead and that was it..................
90% of older daily aspirin users who have a bleeding incident are also taking a prescription blood thinner!
That personal decision is so stupid, I do not even know what to say.
Are there studies for older daily aspirin users who do NOT take a blood thinner?
My own instinctive guess - the aspirin users are healthier than the non-users.
I used to take a blood thinner, Eliquis, for two months after my quad by-pass. $1000 per month was excruciating!................$5 for a bottle of aspirin is much better!..........
I have -
1. Type 2 diabetes
2. Borderline high blood pressure
3. My Triglyceride cholesterol is high, NOT good.
4. My LDL cholesterol is low, good.
5. My HDL cholesterol is high, good.
.
My diet is pretty healthy.
I get a decent amount of exercise (in warm weather, anyway…)
.
.
My self-prognosis is - I will live, until I no longer do.
And have a reasonably healthy & fun time doing it!
By the way - I’m 60.
Follow the science, but be ready to zig zag.
I’m 70 and that sounds just like me!............
“…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.”
———————
I used to be in that latter group, until these studies came out, when I stopped taking a daily aspirin…then last summer I had a heart attack caused by a blood clot.
I will never know if that heart attack would have been prevented if I had kept taking the aspirin, but I strongly suspect that this is the case. Ironically enough, the 911 operator told my wife to give me 4 baby aspirins to chew while waiting for the paramedics to show up. Now I m on aspirin, another blood thinner (because I have 3 stents), a statin (which I am hoping to get rid of or decrease the dosage of) and blood pressure meds (and my BP wasn’t all that high, but this prevents damage to the arteries that causes further plaque build-up).
Lesson learned: Big Pharma absolutely HATES it when people take cheap OTC meds or nutrients to stay healthy, and they’re willing to spend many millions to finance studies to scare people into stopping such treatment in order to make a few bucks. I will take all such studies with the appropriate seriousness (basically, none) going forward. I advise everyone else to read, read, read to understand medical science as best as possible for their own benefit, and understand how the flow of money affects the studies undertaken and breathlessly reported in the media.
You can always take acetylsalicylic acid instead.
My blood is thin, it is what saved my life long enough to get on aspirin when I was diagnosed with clot shot. One full aspirin a day was prescribed, which I took for about a year until I started having bruises. I cut to one small aspirin a day.
One study I read found that a small aspirin every third day still held thinning properties. That study was for normal people, not those with clot shot. My thinner blood allows me to be on that routine even though I still have the Fauci clots.
Occasionally I have a small pain in one spot in my calf which apparently is clotting. I temporarily up my aspirin a little.
“This “dietary cholesterol causes heart attacks” myth needs to be thrown out.”
———————
Yes, it is nonsense. That’s like thinking that just because there are a lot of firemen present when there’s a fire, that they caused it. No, just like firemen, cholesterol is present in your artery walls (as PART of plaque) to deal with an already existing and underlying problem…in this case, inflammation and micro-tearing in the arteries, caused by too much insulin for too long, in turn caused by too much carbs in the diet.l (some people say too much sugar, but your body deals with ALL carbs (except fiber) in the same way, with an increase in insulin).
But simply reducing carbs will lessen the need for both statins and diabetes medications, so Big Pharma spends millions every years to continue to blame cholesterol for heart disease when it is a mere symptom.
The research into the best chicken parmigiana / eggplant parmigiana
and best crab cakes in the mid-Atlantic region is proceeding quite well.
I think my health & diet priorities are about correct.
Of course there is no vegetable nor fruit gardening going on here now
because it is cold as a witches elbow right now - and I’m still in the
construction phase of greenhouse building. When the greenhouse(s)
are complete, I will then be knee deep is fresh salads!
But I’m still working on it at the moment…
.
www.dreamstime.com/royalty-free-stock-photo-fresh-garden-salad-image17658125
I'm now 86 years old and have no sign of cardiovascular disease.
I have never used tobacco (except for a few youthful indiscretions), hardly drink alcohol at all, eat seafood but no other meat; limit NaCl, cholesterol, saturated fats; watch diet carefully; exercise regularly.
My internist said to me, "You have beaten the curse."
Apparently so.
Every morning I weigh and take blood pressure--three readings in the left arm, three in the right arm, then record and graph the average. This keeps me honest with myself. I take Ozempic 2 mg every week, necessary to keep my weight down though I eat very little--my metabolism!
I used to exercise vigorously, had to stop running because of my knee. I now walk briskly at 3.5 miles/hour on the treadmill for 30 minutes every day. That seems to do it.
My wife has a similar schedule and health status. She taught me a lot about self-discipline.
All this health care pays off. Once you get in the habit, it's easy.
EXACTLY!!!
Death to carbs, have a steak instead!
I drink maybe 3 cups of coffee a day.
I quit drinking alcohol years ago. Drank enough in my Marine Corps youth to last me a lifetime.
Try reading this:
Congratulations!
Bookmarked. I will have a look-see when I have the time. Thanks!
good logic.
And tinnitus
Bump
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