New guidelines don't recommend aspirin for heart disease prevention

(CBSDFW.COM) - The US Preventive Services Task Force (USPSTF) says people over the age of 60 should not take low-dose aspirin for prevention of cardiovascular disease.

The new guidelines released Tuesday also say people 40 to 59 years old should make their own decision on taking aspirin. The task force says the benefit is small for this age group. 

We spoke with Dr. Amit Khera, Cardiologist for the UT Southwestern Medical Center, about the new guidelines. 

Dr. Khera: If you already have had a heart attack and stroke, these guidelines do not pertain to you. Largely, it's a good thing to review the new evidence every few years, the last USPSTF guideline was 2016. So a lot has happened and mainly some new studies came out that really helped us understand that balance of risk and benefit with aspirin. It was time to sort of relook at that.

What do we make of this?

Dr. Khera: That's what these guidelines do, they give us specific parameters. Essentially what they say is if you are 40 to 59 years old, and if your risk of having a heart attack or stroke is a little bit higher, so here they use 10% risk in the next 10 years or higher. If you don't have a lot of bleeding issues, then aspirin may be right for you. I think the key point here is that rather than using aspirin routinely, which people did in the past, we need to be more selective and have a conversation with your provider to determine if that's appropriate for you.

What are the old guidelines?

Dr. Khera: The old guidelines had a different age range, they're a bit older, 40 to 69. I think the biggest thing that we're realizing that change these guidelines is the issue with bleeding. In the most recent studies now that people are smoking less and better treatment of cholesterol, and so forth, we realized that the benefit of aspirins a little bit smaller. Importantly, we're really realizing the increase in major bleeding. A lot of people think of aspirin like a vitamin almost, but we're talking bleeding in the brain bleeding ulcers, and hospitalization for bleeding. For most people, on average, you're going to cause more major bleeding than heart attacks and strokes you avoid. That what led to these new guidelines. But, in those whose risk of a heart attack or stroke is still higher, that don't have a lot of bleeding issues, it may be right for them. But again, more selective in use.

What does aspirin really do?

Dr. Khera: Aspirin affects the platelets, which are involved in blood clotting. That's what a heart attack is You all of a sudden develop a blood clot in your heart artery and there's no blood flow. So, aspirin can keep that blood clot from forming to prevent a heart attack. Similarly, when we talk about brain arteries, that's a stroke. So, that's what aspirin does. At the same time, if you keep blood from clotting, you can also increase bleeding.

So that's why they came up with the new guidance?

Dr. Khera: We always looked at the plus side of aspirin. We're always focused on how it benefits individuals and we really weren't paying much attention to the harm. But, given that the benefits have reduced somewhat, they're still there, but they've reduced somewhat in the modern era, we do need to pay attention to those harms a little bit more.

What should people know and do with the new guidelines? 

Dr. Khera: I think the best way is always talk to your physician, talk to your provider, and weigh the risks and benefits. What we want people to avoid doing is just routinely taking aspirin on their own to prevent, you know, for years and years, to prevent a heart attack and stroke. That's what these guidelines are saying is that it should not be routine practice. It should be more individualized and talking to your provider and seeing if this is the best thing for you. 

When you run a risk for heart disease, what are the risks? 

Dr. Khera: There's a calculator from the US cholesterol guidelines where you plug in your characteristics, your age, your gender, your your cholesterol, blood pressure, diabetes, etc. It will tell you in the next 10 years, what's your chance of having a heart attack or stroke. It's publicly available. If it's above 10% And you don't have a high risk of bleeding, Aspirin still may be okay for you.

Can we say safely that people were using aspirin as vitamins and not talking to the doctor?

Dr. Khera: Aspirin has been around literally for thousands of years and people just assume it's benign and has no no downsides. That's not correct and that that's the focus here in realizing that aspirin can be beneficial, but it also has harms and we've ignored those harms all along. When we're talking about preventing heart attacks and strokes, people are taking it for decades, and that can really lead to ulcers and bleeding risk. We just have to make sure we're picking the right patients.