Cardiologist explains why an aspirin a day is no longer right for everyone

A medical task force issued the new guidelines in a “Draft Recommendation Statement” Tuesday, adjusting the group’s advice regarding the use of a low-dose aspirin a day to prevent heart attacks. Straight Arrow News Medical Expert and Cardiologist Dr. Payal Kohli explains the new health guidance on taking aspirin for heart health.

“When I was in training, the the saying was always an aspirin a day keeps the doctor away,” says Dr. Kohli. “But if you’re someone who is otherwise pretty healthy, over the age of 60, you’re not somebody that I would start aspirin on today in 2021, based on this new science.”

In a statement, the U.S. Preventative Services Task Force said, “People age 60 or older should not start taking aspirin for heart disease and stroke prevention,.”

If finalized, the aspirin advice for older adults would backtrack on recommendations the panel issued in 2016 for helping prevent a first heart attack and stroke.

“Based on new evidence since the 2016 task force recommendation, it is now recommended that once people turn 60 years old, they should not consider starting to take aspirin because the risk of bleeding cancels out the benefits of preventing Cardiovascular Disease (CVD),” the task force said in its statement. “The most serious potential harm is bleeding in the stomach, intestines, and brain. The chance of bleeding increases with age and can be life-threatening.”

Tuesday’s adjustment would be in line with more recent guidelines from other medical groups. Also in its statement, the task force said for the first time there may be a small benefit for adults in their 40s who have no bleeding risks.

“The latest information also shows a closer balance of benefits and harms than previously understood for people in their 50s and that starting aspirin use as young as 40 years old may have some benefit,” the task force said. “People ages 40 to 59 who are at higher risk for CVD and do not have a history of CVD should decide with their clinician whether to start taking aspirin.”

The task force warned when giving its new aspirin advice that it “only applies to people who are at higher risk for CVD, have no history of CVD, and are not already taking daily aspirin”. People who are at a high risk for CVD include those with high blood pressure, high cholesterol, or obesity.

As for people who have already had a heart attack or stroke, and are already taking aspirin daily, “They should continue to do so unless told otherwise by their clinician,” task force member Dr. Chien-Wen Tseng said in the statement.