New Aspirin Recommendations: What to Know
Oct 26, 2021 Cedars-Sinai Staff
Confused by recent news about aspirin and heart health? Here's the bottom line: If you take daily, low-dose aspirin per your doctor's orders, don't stop now. New recommendations, however, from a volunteer task force of experts in preventive health suggest—in part because of changes in general habits and new medical insights—aspirin isn't as beneficial for people who don't have heart disease.
Here, we speak with Dr. C. Noel Bairey Merz, director of the Barbra Streisand Women's Heart Center, and cardiologist Dr. Raj Khandwalla, about what you need to know about aspirin and your heart health.
"Aspirin was such a mainstay of our recommendations for so long, but people have changed over the last 40 years. Our goal is to try to personalize our recommendations for each patient."
The new recommendations only apply to people who don't have existing heart conditions
The task force findings do not apply to people who have cardiovascular disease, or those who have had a stent, coronary bypass, heart attack or stroke. Aspirin is still recommended for secondary prevention.
People older than 40 without a history of cardiovascular disease should talk with their doctor at their next scheduled checkup about whether they should start or stop taking aspirin for primary prevention.
Patients should discuss aspirin use with their doctors at their next checkup
The task force made the new recommendation for several reasons. Smoking rates have declined in people over 65, and people eat healthier diets and take medications to control blood pressure and cholesterol. As a result, heart attack rates are down, and fewer people are dying of cardiovascular disease, and aspirin for primary prevention doesn't have the same impact it had in decades past.
But public health recommendations don't necessarily apply to everyone, says Dr. Bairey Merz. Every patient, with heart disease or not, should seek personalized guidance and make a shared decision with their physician.
Dr. Khandwalla says Cedars-Sinai physicians have already been heeding new scientific evidence and prescribing aspirin more selectively to patients who would benefit.
"We have been following the results of clinical trials for the last four years, and we have been taking some people off of aspirin," he says. "Aspirin was such a mainstay of our recommendations for so long, but people have changed over the last 40 years. Our goal is to try to personalize our recommendations for each patient."
The risks of taking aspirin are still relatively low
Daily aspirin can increase the chances of bleeding in the stomach, bladder or brain—and in large populations, the task force found the risk of bleeding outweighs the benefit of preventing heart disease. Bleeding in the stomach is serious and requires invasive intervention—but is still unlikely.
"If you're 67, your dad died of a heart attack at 69 and nobody in your family has had stomach bleeding, you might make the decision to take aspirin, and that's OK," Dr. Bairey Merz says. "If you've already had stomach bleeding, or you have a family history, that's a discussion you should have with your physician."
Dr. Khandwalla says for those who remain concerned about their risk of heart attack and stroke, a coronary calcium scoring test can further determine whether they'd benefit from aspirin. The low-dose CT scan—for patients over the age of 45—can detect plaque in coronary arteries, which could indicate a patient would benefit from cholesterol medication and aspirin.