The US Preventive Services Task Force is considering making several changes to its guidance on taking a daily aspirin to prevent heart disease and stroke.
On Tuesday, the task force posted a draft statement recommending that adults ages 40 to 59 who are at a higher risk for cardiovascular disease – but do not have a history of the disease – decide with their clinician whether to start taking aspirin, based on their individual circumstances.
This is the first time the task force has recommended that adults in their 40s talk to their doctors about whether to take aspirin for heart health.
The draft also says that adults 60 and older should not start taking aspirin to prevent heart disease and stroke because new evidence shows that potential harms cancel out the benefits, according to the task force.
“The latest evidence is clear: starting a daily aspirin regimen in people who are 60 or older to prevent a first heart attack or stroke is not recommended,” Task Force member Dr. Chien-Wen Tseng said in a statement. “However, this Task Force recommendation is not for people already taking aspirin for a previous heart attack or stroke; they should continue to do so unless told otherwise by their clinician.”
The draft recommendation was posted for public comments, which can be submitted from now to November 8.
Heart disease is the leading cause of death in the United States, causing about 1 in 4 deaths. While taking a daily low-dose aspirin has been shown to lower the risk of having a heart attack or stroke in some people, doing so also comes with the serious risk of potential bleeding in the stomach, intestines and brain, according to the task force. That risk of bleeding increases with age.
“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,” Task Force member Dr. John Wong said in a statement. “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 clinician to decide together if starting to take aspirin is right for them.”
The last time the task force made a recommendation on the use of a daily aspirin was in 2016 when it said the decision to start taking low-dose aspirin “should be an individual one” for adults 60 to 69. At the time, the task force recommended a daily low-dose aspirin for adults ages 50 to 59 who have a 10% or greater risk of cardiovascular disease and no increased for bleeding.
The new draft recommendation updates the task force’s 2016 final recommendation on aspirin use to prevent cardiovascular disease and colorectal cancer – but the new draft focuses only on the prevention of cardiovascular disease and calls for more research around taking aspirin to prevent colorectal cancer.
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Other groups previously have pointed to the risks of a daily low-dose aspirin as canceling the benefits.
In 2019, the American College of Cardiology and the American Heart Association released guidelines saying that daily low-dose aspirin is no longer recommended as a preventative for older adults who don’t have a high risk or existing heart disease.
In 2018, a trio of studies published in the New England Journal of Medicine suggesting that a daily low-dose aspirin regimen provides no significant health benefits for healthy older adults. Instead, it may cause them serious harm.