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Taking aspirin daily is a widespread practice in the United States. Photo: AP

In US, advice shifts on daily aspirin use for preventing heart attacks

  • Aspirin use to prevent first heart attacks not recommended for most older adults, US expert panel says
  • Statement a major reversal in the US medical field, where taking aspirin daily is a widespread practice
Medicine
Agencies

US government expert panel said it no longer recommends a daily dose of aspirin to reduce the risk of heart attack and stroke in people aged 60 and over.

The United States Preventive Services Task Force (USPSTF) said it plans to update its 2016 recommendation as there is new evidence that the risk of potentially life-threatening internal bleeding from regular aspirin use increases with age.

The statement was a major reversal in the US medical field. Aspirin, used for decades for pain and fever and available without a prescription, was seen as a convenient and cheap option to help those at risk of serious heart problems.

The task force, a panel of 16 independent experts in disease prevention appointed by the US Department of Health and Human Services, also said evidence was insufficient to say that low-dose aspirin use reduces the occurrence or death due to colorectal cancer.

The pros and cons of a daily aspirin

The recommendation, if finalised, would replace an earlier one from the panel, which in 2016 said daily low-dose aspirin may also help protect against colorectal cancer in people who are taking it to prevent heart attacks and strokes.

The new recommendation does not include people who have previously suffered a heart attack or stroke and taking daily aspirin to prevent a subsequent cardiovascular event. The panel said they should continue the regimen unless told otherwise by their doctor.

Since 2016, a US government medical expert panel has recommended a daily dose of aspirin for people in their 50s at risk of heart attack. Photo: AP

“It’s hard to know the degree to which any particular piece of evidence, whether an individual study or a practice guideline, will ultimately move the field,” said Caleb Alexander, professor of epidemiology at Johns Hopkins Bloomberg School of Public Health, who was not a member of the task force.

Researchers have been assessing daily low-dose aspirin use for people who do not have a history of heart disease but who are at high risk of developing it due to health issues such as high cholesterol and blood pressure.

“Daily aspirin use may help prevent heart attacks and strokes in some people, but it can also cause potentially serious harms, such as internal bleeding,” said task force member John Wong. “It’s important that people who are 40 to 59 years old and don’t have a history of heart disease have a conversation with their doctor to decide together if starting to take aspirin is right for them.”

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For people aged 50 to 59, the USPSTF previously recommended the pill only for those who have at least a 10 per cent risk of heart attack or stroke over the next decade and who do not have a higher-than-average risk of bleeding.

An estimated 600,000 Americans suffer a first heart attack, and about 610,000 a first stroke.

Taking aspirin to reduce this risk of heart disease is often a spontaneous decision for many Americans. According to a 2017 study, 23 per cent of adults aged 40 and over who don’t have cardiovascular disease took aspirin as a preventive measure, of whom 23 per cent did so without a doctor’s recommendation.

Wong acknowledged that the backtracking might leave some patients frustrated and wondering why scientists can’t make up their minds.

“It’s a fair question,’’ he said. ‘’What’s really important to know is that evidence changes over time.

Reuters, Agence France-Presse and Associated Press

This article appeared in the South China Morning Post print edition as: Advice shifts on aspirin use for heart health in US
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