In last week’s column I wrote about key cancer screening guidelines all adults should be aware. This week, I’m reviewing a critical update you may have missed earlier this year for a drug that many Americans take daily: aspirin.
Low-dose aspirin has been a popular preventative measure for years. Millions of Americans take aspirin daily, including 29 million who do not carry a diagnosis of cardiovascular disease. A standard 6.6 million do so without a doctor’s supervision.
Earlier this year, the United States Preventing Services Task Force (USPSTF) made headlines for its latest recommendation on daily aspirin use. The USPSTF has come out strongly against initiating daily aspirin use in adults 60 and older who did not have a first heart attack or stroke, specifically citing that the risks of internal bleeding outweighed the benefit. Scientists have also found little benefit for daily aspirin for most healthy people.
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Low-Dose Aspirin Disrupts Common Mechanism of Heart Attacks and Strokes
Aspirin is one of the most common and effective drugs we have in our arsenal. It is officially known as acetylsalicyic acid. Although it is also classified as a nonsteroidal anti-inflammatory drug (NSAID), it is often confused with ibuprofen. But the two common drugs are very different. Traditionally, aspirin has been used to treat fever, reduce pain, or ease inflammation.
However, recent guideline updates specifically refer to its common long-term use in preventing heart attacks, ischemic strokes, or blood clots in patients deemed to be at high risk.
Aspirin’s ability to suppress normal platelet function is why it is used for preventive purposes. When our blood vessels are damaged, the body sends platelets to stop the bleeding. Upon arrival, the platelets clump together or clump together.
However, abnormal platelet aggregation in people with cardiovascular disease can lead to heart attacks or strokes. Low-dose (“baby”) aspirin irreversibly blocks platelets from producing a substance called thromboxane A2. Thromboxane A2 both stimulates the activation of new platelets and increases platelet aggregation, or clumping. As such, low-dose aspirin is an inexpensive but powerful potential tool against the abnormal clumping of platelets that could lead to heart attack or stroke in people at high risk of cardiovascular disease.
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Guidelines reflect concerns about increased risk of bleeding from aspirin
To be clear, the new USPSTF guideline does not call into question the proven benefit of aspirin in preventing heart attacks or strokes. Scientists reaffirm that the benefits of aspirin probably outweigh the risk of side effects specifically for those who haveho have already had a first heart attack or stroke.
However, scientists are concerned about the risk of side effects among the aforementioned millions of Americans who take aspirin daily without a doctor’s supervision and without an actual diagnosis of cardiovascular disease.
In the ER, we do not recommend aspirin and other NSAIDs like ibuprofen and naproxen for patients with peptic ulcer disease, gastritis, hemophilia, kidney disease, and other conditions because the aspirin is known to increase the risk of gastrointestinal bleeding. Although beneficial in reducing the future risk of heart attack or recurrent stroke, aspirin’s ability to reduce platelet aggregation also results in blood thinning. Aspirin also unfortunately inhibits stomach protective substances like prostaglandins which make people more susceptible to ulcers, gastritis and other complications.
Aspirin made simple: what you need to know
The update can be confusing to interpret. But here are the recommendations broken down more simply:
- Adults who have a stent or who have had a heart attack or stroke in the past should not stop taking aspirin
- Adults 40 to 59 years old at high risk of cardiovascular disease: Decide with your doctor if you should start taking daily aspirin. Your doctor will do an evaluation to see if you have a 10% or greater 10-year risk of cardiovascular disease.
- Adults 60 and older without cardiovascular disease: do not start taking a daily aspirin
There are many other proven ways to reduce your risk of cardiovascular disease instead of taking a daily aspirin. Regular exercise (even just 30 minutes a day of brisk walking), better food choices, meditation and other stress reductions, and healthy sleep habits all have proven benefits – and best of all, no risk of heart failure. dangerous side effects.
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