Dr. Batchelor

New recommendations discourage aspirin use as preventive heart measure for some, but patients should talk to their doctor before discontinuing daily aspirin use.

Wayne Batchelor, MD, is Director of Interventional Cardiology and Interventional Cardiology Research at the Inova Heart and Vascular Institute. His outpatient practice is based at the Inova Cardiology Fairfax office. He is board-certified in cardiovascular disease with added qualifications in interventional cardiology.

“An aspirin a day keeps the doctor away” is a long-used maxim almost as popular as the adage touting an apple. But while taking low-dose aspirin to prevent heart attack and stroke was once more widely recommended, new guidelines whittle down whom daily aspirin use can still benefit while pointing out the regimen’s potential pitfalls.

In 2019, the American College of Cardiology and American Heart Association issued a joint update of guidelines steering the use of daily aspirin to avoid a first heart attack or stroke. But the measure – based on growing research on aspirin-related bleeding problems – has left many wondering if they should still use low-dose aspirin.

Talk with your doctor. Do not decide on your own to start or discontinue aspirin use.

This created a lot of confusion for patients; years ago, we noticed if patients took aspirin, the likelihood of them experiencing a heart attack or another major cardiovascular event was significantly lowered.

But patients back then were not doing a whole lot otherwise to lower their risks. Now we’re better at treating high blood pressure, cholesterol medications are more effective, and smoking rates have dropped. Overall, these factors have reduced the risks considerably for many patients.

Aspirin’s Effects

Low-dose aspirin – defined as 81 mg, the amount in a baby aspirin (compared to a standard aspirin tablet which is 325 mg) – can lower the risk of heart attack or stroke by thinning the blood, discouraging clots. But in some patients, especially those over age 70, these benefits are offset by higher risks of bleeding.

The new guidelines balance these pros and cons.

Aspirin should NOT be routinely recommended for:

  • People with no personal history who are considered at lower risk of heart attack or stroke.
  • Patients over age 70.
  • Patients considered at increased risk of bleeding.

Aspirin is recommended for:

  • Those who have already had a heart attack or stroke to reduce the risk of a second cardiovascular event.
  • Patients who have undergone certain interventions or procedures, such as bypass surgery or stent placement to open narrowed blood vessels.

Aspirin may be considered:

  • For those considered at high risk of a first heart attack or stroke due to factors such as strong family history, poor diabetes control, high cholesterol and/or high blood pressure.
  • For patients between ages 40 and 70 who aren’t at increased risk of bleeding.

Caution: Talk to Your Doctor

However your individual health situation may overlap with the updated guidelines, it is very important that you do not decide on your own to start or discontinue aspirin use.

We’re actually seeing, as a result of these recommendation changes, some people taking it upon themselves to stop taking aspirin. In some cases, that’s a real tragedy since they need to be on aspirin for secondary prevention because they already have established heart disease. This isn’t something you should figure out on your own.

If you haven’t had a prior heart attack or stroke, how can you and your doctor decide whether your risk factors point toward daily aspirin use? An annual physical and discussion of your family heart history with a primary care provider is the first step. Another indicator to bring to your discussion with your doctor would be results from a simple-to-use online cardiac health risk assessment.

Another, more sophisticated, online tool that requires specific clinical values is called the Atherosclerotic Cardiovascular Disease (ASCVD) Risk Calculator. This tool allows you to plug in age, gender, race, blood pressure and cholesterol levels and offers a percentage risk of suffering a significant cardiovascular event over the coming 10 years.

Your doctor can help with this, and sometimes an app isn’t needed to determine if patients should be on aspirin. But it’s not like one brush stroke can be applied to every single patient. We need to hit the mark on the balance between aspirin’s risks and benefits.

RELATED: Inova HealthChat podcast: Listen to Dr. Wayne Batchelor discuss more about the use of aspirin to prevent heart attacks

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