Patients Should Use Caution When Taking Aspirin

Health-System Edition, November 2021, Volume 10, Issue 6

New guidelines suggest older individuals should not start taking the drug for heart disease or stroke prevention.

Aspirin's mechanism of action was identified in 1971 as inhibiting irreversible cyclooxygenase and reducing prostaglandin production.1,2

In 2007, approximately 20% of American adults took aspirin every other day for heart health. In individuals who were aged 65 years or older, nearly 50% were taking the drug, according to the Agency for Healthcare Research and Quality.1

Although a low-dose aspirin regimen became commonplace as a staple of cardiovascular health and medicine because of aspirin’s preventive properties, updated findings are challenging this long-standing practice.

For many years, it was recommended that prescribers start individuals at increased risk of heart disease or stroke on low-dose daily aspirin.3 However, new data show there can be more risk than benefit for certain groups.

Draft guidelines released by the US Preventive Services Task Force (USPSTF), which consists of a panel of experts in disease prevention and evidence-based medicine, assert that there is strong evidence to support the development of serious adverse effects from taking once- daily aspirin versus the potential benefits, especially in certain populations.4

The possible harm in older individuals is believed to outweigh the potential benefits of what had been considered an inexpensive method in the battle against heart disease, according to the task force.4 The risk of life-threatening internal bleeding can increase from daily aspirin use with increasing age. Thus, if an individual does not present with the risk of heart attack or stroke, this regimen is now not recommended.5

In addition, the USPSTF recommends that individuals 60 years or older who do not have a history of heart attack or stroke do not initiate aspirin therapy.6 The task force also plans to revise its 2016 recommendation on the use of baby aspirin as a preventive measure for colorectal cancer, given data that raise specific questions about its potential benefit for cancer.6

As a result of the proposed changes to the guidance by the USPSTF, millions of Americans will be affected. Because heart disease is the leading cause of death in the United States, these draft recommendations indicate that patients, particularly those aged 40 to 59 years, should talk to their providers about whether to take aspirin.7

The decision to initiate low-dose aspirin for the primary prevention of cardiovascular disease in patients aged 40 to 59 years who have a 10% or greater 10-year cardiovascular risk should be made on a case-by-case basis, because the benefit of daily aspirin in this group is small.7

Those individuals aged 40 to 59 years who have a higher risk of cardiovascular disease but do not present with a history of the disease should discuss with their providers whether they need an aspirin regimen based on their circumstances.7,8

Abimbola Farinde, PHD, PHARMD, is a professor of health care administration at Columbia Southern University in Orange Beach, Alabama.

Reference

1. Ittaman SV, VanWormer JJ, Rezkalla SH. The role of aspirin in the prevention of cardiovascular disease. Clin Med Res. 2014;12(3-4):147-154. doi:10.3121/cmr.2013.1197

2. Miner J, Hoffhines A. The discovery of aspirin’s antithrombotic effects. Tex Heart Inst J. 2007;34(2):179-186.

3. Chiu A. Americans should limit use of daily aspirin meant to prevent heart attack or stroke, task force says. Washington Post. October 12, 2021. Accessed October 27, 2021. https://www.washingtonpost.com/lifestyle/2021/10/12/low-dose-aspirin-heart-attack-stroke/

4. Rabin RC. Aspirin use to prevent 1st heart attack or stroke should be curtailed, US panel says. New York Times. October 12, 2021. Accessed October 27, 2021. https://www.nytimes.com/2021/10/12/health/aspirin-heart-attack-stroke.html

5. Maddipatla M. Aspirin use to prevent first heart attacks not recommended for most older adults-US panel. Reuters. October 12, 2021. Accessed October 27, 2021. https://www.reuters.com/business/healthcare-pharmaceuticals/aspirin-use-prevent-first-heart-attacks-not-recommended-most-older-adults-us-2021-10-12/

6. Tanner L. Advice shifting on aspirin use for preventing heart attacks. U.S. News & World Report. October 12, 2021. Accessed October 27, 2021. https://www.usnews.com/news/health-news/articles/2021-10-12/advice-shifting-on-aspirin-use-for-preventing-heart-attacks

7. Aspirin use to prevent cardiovascular disease: preventive medicine. US Preventive Services Task Force. October 12, 2021. Accessed October 27, 2021. https://www.uspreventiveservicestaskforce.org/uspstf/draft-recommendation/aspirin-use-to-prevent-cardiovascular-disease-preventive-medication

8. Howard J. US task force proposes adults 60 and older should not start daily aspirin to prevent heart disease or stroke. CNN Health. Updated October 13, 2021. Accessed October 27, 2021. https://www.cnn.com/2021/10/12/health/daily-aspirin-heart-disease-stroke-draft-recommendation-wellness/index.html