Low dose daily aspirin is no longer recommended in elderly people

If you are a healthy senior and are looking for ways to reduce your risk of heart attack and stroke, do not worry about this age-old expectation: low-dose daily aspirin. This drug is no longer recommended as a preventative in elderly people with no high cardiac risk or existing heart disease, according to guidelines announced Sunday by the American College of Cardiology and the American. Heart Association.

"For the most part, we are now much more effective at treating risk factors such as hypertension, diabetes, and especially high cholesterol," said North Carolina cardiologist Kevin Campbell. who was not involved in the new guidelines. "This makes the biggest difference, probably reversing any previously perceived benefit of aspirin in primary prevention."

Doctors may consider aspirin in some high-risk elderly patients, such as those who have difficulty lowering their cholesterol or managing their blood glucose, as long as there is no increased risk of internal bleeding, according to the guidelines. . European guidelines recommend not using anticoagulant treatments such as aspirin at any age.

"Clinicians should be very selective in prescribing aspirin to people not suffering from known cardiovascular disease," said Dr. John Hopkins cardiologist Dr. Roger Blumenthal, who co-chaired the new guidelines, in a statement. "It's much more important to optimize lifestyle and control blood pressure and cholesterol than to recommend aspirin."

The use of aspirin in younger age groups "is now a clbad 2b recommendation," said Campbell, "which means it's not necessarily the best solution, there's a lot debates between experts and the data are not definitive ".

However, personally, Mr. Campbell stated that he "would advocate a healthy lifestyle, quitting smoking and changing risk factors even before considering treatment at the same time. aspirin in a patient without known cardiovascular disease ".

However, aspirin can save the lives of all people who have suffered a stroke, heart attack, open heart surgery or inserted stents to open clogged arteries.

"Ultimately, we need to individualize the treatment of each patient according to his particular situation," Campbell said.

New research on aspirin

Three recent studies have shown that daily low-dose aspirin use is at best a waste of money for healthy seniors. At worst, this can increase their risk of internal bleeding and premature death.

"Aspirin should be limited to people with the highest risk of cardiovascular disease and a very low risk of bleeding," said Blumenthal.

Patients should work closely with their doctor to establish the risk of bleeding. This risk increases as one gets older or develops kidney disease, heart disease, diabetes, and high blood pressure. A history of ulcers or bleeding, especially in the gastrointestinal tract, or anemia are also risk factors. Some medications, such as nonsteroidal anti-inflammatory drugs, steroids, direct oral anticoagulants, and warfarin, an anticoagulant, may also increase the risk of bleeding.

The guidelines emphasize that statins must be used to prevent heart disease in people with LDL levels above 190 milligrams per year. deciliter. LDL is synonymous with low density lipoprotein and is the "bad" cholesterol that clogs the arteries and leads to heart disease.

Change the recommendations on type 2 diabetes

Type 2 diabetes is one of the leading risk factors for cardiovascular disease and the 2019 guidelines emphasize that a diet, exercise and weight control system is the first offense. As recommended, try at least 150 minutes a week of moderate intensity exercise, such as brisk walking and swimming. Then get started for 75 extra minutes of high intensity exercises, such as running and circuit training.

First-line drugs should include metformin, as directed. If additional drugs are needed, two new clbades of drugs are promising to reduce cardiovascular events in type 2 diabetics: SGLT-2 inhibitors, which act to increase the elimination of glucose and sodium by the kidneys ; and GLP-1R agonists, which increase the production of insulin and glucose in the liver.

New research on these two clbades of diabetes medications shows that they can also reduce the risk of heart attack, stroke and related deaths, according to the guidelines.