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What does aspirin a day to prevent heart disease? You may need to put it away.
The American College of Cardiology and the American Heart Association revised their joint guidelines in March.
For decades, doctors had recommended low-dose aspirin to prevent atherosclerotic cardiovascular disease (some types of heart attacks, illnesses and strokes).
"Previously, we had said that anyone over the age of 50 should take an aspirin," says Dr. Paul Tucker, a cardiologist at St. David's South Austin Medical Center in Austin, Texas.
The new recommendations tell doctors not to give it to patients aged 70 and over for prevention purposes unless they belong to a selected group of people who have already had a heart attack, stroke or a similar incident or have high risk factors. It should be avoided in anyone with a high risk of bleeding.
The problem is that the risk of bleeding outweighs the benefits of prevention.
In September, a study of 19,000 people aged 70 or older who received aspirin or placebo showed no difference in rates of disability, dementia, and death. The researchers found an increased risk of bleeding.
What does it mean for people who take aspirin to prevent a heart attack or stroke?
Ask your doctor, says Tucker. "I still think it's up to the doctors and their patients," he says.
The most important risk badociated with aspirin is bleeding from the gastrointestinal tract. This usually results in a color change of the stool (it looks black or much darker) or nausea or vomiting of blood or an object resembling coffee grounds.
"It's still very rare," says Tucker.
What he and other cardiologists need to do is examine each patient and weigh the bleeding risk of that patient in relation to the risk of heart attack. It may also be that, in some patients, it is not a recommendation "no aspirin at all, but less aspirin", such as a baby aspirin twice a week or three times a week to inhibit platelets but do not cause bleeding.
"It's the art of medicine, rather than science," he says. He could tell his patients, "I know the guidelines, but you're at high risk of having a heart attack and you've never had stomach bleeds."
Instead, it will examine their risk factors, including diabetes, smoking, obesity, genetics, cholesterol, blood pressure, and calcium score in the coronary artery. There is a calculator used by doctors to badess the risk.
Then he could choose other treatments to control high levels of cholesterol, blood pressure or blood sugar, or, if the patient is really at risk, he can continue to use aspirin.
"The guidelines are important," he says, "but we need to discuss the characteristics of each patient."
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