New Guidance: Don’t take daily Aspirin

New Guidance: Don’t take daily Aspirin

daily low dose aspirin

A prevailing and rather popular practise has been the consumption of a daily low dose of Aspirin to help prevent cardiovascular disease. Literally millions of people are currently doing this.

The current medical consensus is that this does more harm than good. There is a new report via a team of Harvard researchers that conforms that literally millions of people are doing this and are unaware that it does more harm than good.

If not Aspirin, then what?

We will come to that in a moment. Let’s first take a quick pass at the new report.

Via the new Report: How many do this?

  • Nearly 30 million Americans older than 40 take aspirin daily to prevent cardiovascular disease
  • More than 6 million Americans take aspirin daily without physician’s recommendation
  • Nearly half of Americans more than 70 years of age without cardiovascular disease, an estimate of nearly 10 million people, take aspirin daily – despite current guidelines against this practic

It is like this because the medical consensus that prevailed was that the daily use of low dose aspirin to prevent heart attack and stroke in people at increased risk for cardiovascular disease (CVD) was beneficial.

What changed and why?

Better evidence emerged.

It all changed last year. In 2018 there were three major clinical trails that revealed that a daily intake of low-dose Aspirin resulted in few benefits and also brought an increased risk of bleeding. Because of the new evidence the American Heart Association and American College of Cardiology issued new clinical practice guidelines earlier this year. They recommended against the routine use of aspirin in people older than 70 years or people with increased bleeding risk who do not have existing cardiovascular disease.

You can find that guidance here: 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease (This guidance is dated February 2019 and runs to over 98 pages)

One of the key points from the above guidance is …

Aspirin should be used infrequently in the routine primary prevention of ASCVD because of lack of net benefit.“.

What does the latest Report tell us?

Within the Annals on Internal Medicine a team of Harvard researchers have published a report on the 23rd July 2019 titled “Prevalence of Aspirin Use for Primary Prevention of Cardiovascular Disease in the United States: Results From the 2017 National Health Interview Survey“.

This reveals that Aspirin use is widespread among groups at risk for harm including older adults and adults with peptic ulcers – painful sores in the lining of the stomach that are prone to bleeding that affect about one in ten people.

Additional comments by the Report Authors

Senior author Christina C. Wee, MD, MPH, a general internist and researcher at BIDMC and Associate Professor of Medicine at Harvard Medical School….

Although prior American Heart Association and American College of Cardiology guidelines recommended aspirin only in persons without elevated bleeding risk, the 2019 guidelines now explicitly recommend against aspirin use among those over the age of 70 who do not have existing heart disease or stroke, Our findings suggest that a substantial portion of adults may be taking aspirin without their physician’s advice and potentially without their knowledge.”

Lead author Colin O’Brien, MD, a senior internal medicine resident at BIDMC and fellow at Harvard Medical School…

“Our findings show a tremendous need for health care practitioners to ask their patients about ongoing aspirin use and to advise them about the importance of balancing the benefits and harms, especially among older adults and those with prior peptic ulcer disease,”

Coauthor, Stephen Juraschek, MD, PhD, a primary care physician at BIDMC, cautions …

“these findings are applicable to adults who do not have a history of cardiovascular disease or stroke. If you are currently taking aspirin, discuss it with your doctor to see if it is still needed for you.”

If not Aspirin, then what?

This is perhaps the important bit. No, I’m not about the try and sell you some dubious supplement. I don’t do ads and I have no interest in selling crap that does nothing.

What is your best strategy, what is known to actually work and is your best scientific evidence-based solution for optimal health?

The answer turns out to be rather well-known, is robustly evidence based, and hence is the very obvious:

Maintain a good diet, get sufficient exercise, and don’t smoke.

To be a bit more specific, the AHA guidelines issued in February 2019 list it out within their 98 page document as follows …

Top 10 Take-Home Messages for the Primary Prevention of Cardiovascular Disease

  1. The most important way to prevent atherosclerotic vascular disease, heart failure, and atrial fibrillation is to promote a healthy lifestyle throughout life.

  2. A team-based care approach is an effective strategy for the prevention of cardiovascular disease. Clinicians should evaluate the social determinants of health that affect individuals to inform treatment decisions.

  3. Adults who are 40 to 75 years of age and are being evaluated for cardiovascular disease prevention should undergo 10-year atherosclerotic cardiovascular disease (ASCVD) risk estimation and have a clinician–patient risk discussion before starting on pharmacological therapy, such as antihypertensive therapy, a statin, or aspirin. In addition, assessing for other risk-enhancing factors can help guide decisions about preventive interventions in select individuals, as can coronary artery calcium scanning.

  4. All adults should consume a healthy diet that emphasizes the intake of vegetables, fruits, nuts, whole grains, lean vegetable or animal protein, and fish and minimizes the intake of trans fats, processed meats, refined carbohydrates, and sweetened beverages. For adults with overweight and obesity, counseling and caloric restriction are recommended for achieving and maintaining weight loss.

  5. Adults should engage in at least 150 minutes per week of accumulated moderate-intensity physical activity or 75 minutes per week of vigorous-intensity physical activity.

  6. For adults with type 2 diabetes mellitus, lifestyle changes, such as improving dietary habits and achieving exercise recommendations, are crucial. If medication is indicated, metformin is first-line therapy, followed by consideration of a sodium-glucose cotransporter 2 inhibitor or a glucagon-like peptide-1 receptor agonist.

  7. All adults should be assessed at every healthcare visit for tobacco use, and those who use tobacco should be assisted and strongly advised to quit.

  8. Aspirin should be used infrequently in the routine primary prevention of ASCVD because of lack of net benefit.

  9. Statin therapy is first-line treatment for primary prevention of ASCVD in patients with elevated low- density lipoprotein cholesterol levels (≥190 mg/dL), those with diabetes mellitus, who are 40 to 75 years of age, and those determined to be at sufficient ASCVD risk after a clinician–patient risk discussion.

  10. Nonpharmacological interventions are recommended for all adults with elevated blood pressure or hypertension. For those requiring pharmacological therapy, the target blood pressure should generally be <130/80 mm Hg.

 

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