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 People in their 50s with risk factors for cardiovascular disease -
including high blood pressure, high cholesterol or a history of
smoking - may benefit from starting a daily aspirin regimen and
staying on it for at least a decade, according to the U.S.
Preventive Services Task Force (USPSTF), a government-backed panel
of independent physicians.
A daily low-dose aspirin may also help protect against colorectal
cancer in people who are taking it to prevent heart attacks and
strokes.
Because aspirin can cause bleeding in the stomach and brain, this
advice doesn’t apply to people with bleeding disorders.
“As with any drug, patients and their doctors must balance the
benefits and risks of aspirin,” said USPSTF chair Dr. Kirsten
Bibbins-Domingo of the University of California, San Francisco.
Adults aged 50 to 59 who have at least a 10 percent risk of having a
heart attack or stroke in the next decade can benefit the most from
taking 81 milligrams of aspirin a day, according to the new
guidelines.
The American College of Cardiology provides an online risk
calculator here: http://bit.ly/1UEFYtE.
The advice doesn’t apply to people in their 60s because the bleeding
risk increases with age, however, and the jury is still out on
whether this approach makes sense for people under 50 or over 70,
the Task Force concluded.
“Some people may benefit from aspirin more than others, which is why
there are several recommendations based on age,” Bibbins-Domino
added by email. The Task Force encourages people to talk with their
doctor about whether taking aspirin is appropriate, she said.
Nearly 40 percent of U.S. adults over 50 already take aspirin to
prevent a first heart attack or avoid a second one, according a
research review published with the new guidelines in Annals of
Internal Medicine.
But the Task Force is at odds with the U.S. Food and Drug
Administration, which has denied efforts by Bayer HealthCare LLC to
market aspirin for preventing heart attacks and strokes in people
with no history of cardiovascular disease.
“All that aspirin does if your heart attack risk is really low is
cause you harm,” said Dr. Steven Nissen, who served on an FDA
advisory panel that recommended against widespread use of aspirin
for primary prevention and chairs the department of cardiovascular
medicine at the Cleveland Clinic in Ohio.
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At least one in 10 people taking aspirin don’t need it, recent
research suggests.
Patients can buy aspirin without a prescription, and doctors are
also free to put people on medicines for purposes that aren’t
approved by the FDA.
The FDA did not respond to a request for comment by press time.
Aspirin helps prevent blood cells called platelets from sticking
together and forming clots that clog arteries, leading to heart
attacks and strokes. The drug carries a bleeding risk because the
body also relies on platelet clusters to seal wounds by forming
scabs.
Additionally, aspirin might lower the risk of colorectal cancer by
acting on a biochemical pathway these tumors need to grow, said Dr.
David Weinberg, chair of the department of medicine at Fox Chase
Cancer Center in Philadelphia.
But patients shouldn’t take aspirin for cancer prevention, Weinberg,
who isn’t on the Task Force, said by email. Instead, they should
think of the reduced cancer risk as an added benefit if they already
need aspirin to address the risk of heart attacks and strokes.
“For those persons already at higher risk for cardiovascular
disease, on balance aspirin is a good idea to reduce cardiovascular
disease risk alone,” Weinberg said. “However, it appears it will
also reduce colorectal cancer risk at the same time, which
represents a benefit with little or no additional risk if aspirin is
already indicated.”
SOURCE: http://bit.ly/1i46lF7 Annals of Internal Medicine, online
April 11, 2016.
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