Aspirin Regimen

College of DuPage Nursing Student Randall J. Rooney wrote for Healthy Lombard that for years now, folks at risk of heart attack have been told to take low-dose aspirin daily for prevention of heart disease. Well, hold on to your hats because things are about to change.

As reported by NY Times1 on March 18th, the American College of Cardiology (ACC) changed their recommendations for aspirin regimens. In their 2019 ACC/AHA Guideline on Primary Prevention of Cardiovascular Disease 2, published March 17, the ACC states:

 

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

 

“Lack of net benefit?!”, you might say, “But aren’t I taking my baby aspirin because there IS a benefit??”.

For years doctors have recommended daily low-dose aspirin (100 mg or less) for primary prevention of atherosclerotic cardiovascular disease (ASCVD) in patients aged 70 years and up. ASCVD, in a nutshell, is the buildup of fatty plaques in your arteries, which chokes off the blood supply to vital organs like your brain, kidneys, and heart, which places you at risk of things like heart attack, stroke and kidney failure.

Now, aspirin regimens have been recommended for years to prevent the buildup of these arterial plaques because aspirin has the very neat property of making stuff in your blood ‘slippery’. Aspirin is known to prevent blood platelets from aggregating, which is good if you’re at risk of clots (and bad if you’re at risk of bleeding). The same mechanism that prevents platelets from sticking to each other is believed to work on fats in your blood. By making the lipids in your blood more slippery, aspirin prevents them from sticking together and forming plaques on the walls of your arteries. And it does this for a bargain. Aspirin is much cheaper, available over the counter, and has fewer side effects and risks than prescription blood thinners.

So, what has changed?

Basically, a bunch of scientists published their research recently. Multiple studies were conducted, and the results of each study were pretty consistent: Daily aspirin taken by healthy adults to prevent heart attack and stroke doesn’t work.

Folks have been on these daily regimens of lose-dose aspirin for long enough now that researchers were able to study the effects aspirin to see whether or not it’s as effective at as we all hoped it might be. Turns out, it’s not very effective, and in fact, it may place patients at greater risk for other complications.

In a NY Times article from September of the last year3, Denise Grady quoted the findings of an article published in the Lancet4 which, “ Found no benefit in low-risk patients” to a daily aspirin regimen. Grady also cites The New England Journal of Medicine which published a study indicating the risks of bleeding brought on by daily aspirin use outweighed the benefits of preventing heart disease in diabetic patients5.

Whatever the case may be there appears to be evidence that taking aspirin daily to prevent stroke and heart attack may not be the best course of action for older adults who don’t already suffer from a coronary artery or other arterial diseases.

As with any medical decision you should consult with your physician before making any changes to your planned care. It is recommended to work closely with your healthcare team to determine how best to achieve your desired outcomes. And remember that many risk factors for atherosclerosis and cardiovascular disease are modifiable. Modifiable risk factors including; losing weight, exercise, and eating a low-fat diet rich in legumes, nuts, and whole grains, as well as limiting alcohol intake and quitting cigarettes to regulate blood sugar are all over-the-counter solutions to prevent a heart attack.

References

  1. https://www.nytimes.com/2019/03/18/health/aspirin-health.html
  2. http://www.onlinejacc.org/sites/default/files/additional_assets/guidelines/Prevention-Guidelines-Made-Simple.pdf
  3. https://www.nytimes.com/2018/09/16/health/aspirin-older-people-heart-attacks.html?module=inline
  4. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31924-X/fulltext
  5. https://www.nejm.org/doi/full/10.1056/NEJMoa1804988

 

 

 

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