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Aspirin & Heart Attacks: A Look at the New Primary Prevention Guidelines

Paul A. Gurbel, MD, is the director of the Inova Center for Thrombosis Research and Drug Development at the Inova Heart and Vascular Institute. He is board-certified in cardiovascular disease, internal medicine and interventional cardiology and sees patients at his office in Lutherville, Maryland.

You might have seen the headlines: The American College of Cardiology recently changed its primary prevention guidelines on the use of daily low-dose aspirin for preventing heart attack and stroke.

Unfortunately, a lot of the media reports on this new recommendation haven’t gotten the facts quite right. And a lot of patients are confused about whether they should be taking daily aspirin or not.

Bottom line: Aspirin is still an important treatment for many patients, but it’s not for everyone. Here’s what you should know.

Aspirin and Cardiovascular Disease

Aspirin limits the blood’s ability to clot, which lowers the risk of heart attack and stroke. It’s an important part of our toolkit, and doctors have prescribed it widely for decades.

Under the old guidelines, we used a risk calculator to determine the patient’s risk of having a cardiac event in the next 10 years. That score helped decide who should take daily low-dose aspirin.

But recent studies found the risk calculator often overestimated the actual risk. Those findings led the American College of Cardiology to revisit the primary prevention guidelines. Rather than rely on the risk calculator, the new guidelines recommend looking at the big picture to consider factors including:

  • strong family history of early heart attack
  • poor control of diabetes
  • high cholesterol
  • high blood pressure
  • evidence of coronary artery plaque (determined by a calcium score identified by CT scan)

Like all drugs that prevent clotting, aspirin can increase the risk of bleeding. These new guidelines aim to balance the risks and benefits. In the end, aspirin use should be a joint decision between the patient and the doctor after considering all the risk factors.  

Preventing a Second Heart Attack or Stroke

The new guidelines do not address aspirin use in patients who have previously had a heart attack or stroke. Experts agree that most of these people should take daily aspirin as “secondary prevention.” That means people who have already had a heart attack or stroke should take aspirin to prevent a second cardiac event. The research is clear that aspirin therapy reduces the risk of another heart attack or stroke in these patients.

Aspirin is also recommended for people who have had certain interventions or surgical procedures, such as a stent to open an artery. In such patients, stopping aspirin would put their health at risk.

Aspirin for Lower-Risk Patients

Do patients benefit from daily aspirin if they haven’t had a heart attack or stroke (or an intervention such as a stent)?

Based on the latest research, the new guidelines make the following recommendations for such patients:

  • Aspirin should not be routinely recommended in patients over 70.
  • Aspirin should not be used in patients with increased bleeding risk.
  • Aspirin might be considered for patients age 40 to 70 who aren’t at increased risk of bleeding.

In other words, there are still a lot of patients who benefit from aspirin. But this isn’t something patients should try to figure out on their own. Be sure to talk to your doctor if you think you might be a candidate for daily low-dose aspirin.

Talk to your Doctor: Personalized Cardiac Care

My colleagues and I consider many factors when we decide whether to recommend aspirin therapy to our patients. We can do a lot to prevent heart attack and stroke, but our treatments have to be decided on a case-by-case basis.

So what’s the takeaway? Don’t let the headlines fool you into thinking that aspirin is an outdated treatment. It’s still an important tool for preventing heart attacks and strokes. But you should always talk to your doctor about the pros and cons before starting — or stopping — aspirin therapy. Do you have concerns about your heart health? Learn more about the award-winning doctors at the Inova Heart and Vascular Institute.

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