If you take a low-dose aspirin every day, you have long been known to reduce the chances of another heart attack, stroke or other heart problem in people who have already had one, but the risk does not outweigh the benefits of most other people according to new guidelines.
People without heart disease taking daily aspirin may reduce their risk of heart attack or stroke, but a new study confirms that they also have an increased risk of severe internal bleeding.
Although it has been used for more than a century, the value of aspirin in many situations is still unclear.
It is no longer recommended as a preventative for older adults who do not have a high risk or existing heart disease according to guidelines announced on Sunday.
Doctors may consider aspirin for some older high-risk patients, such as those who have difficulty lowering their cholesterol or administering their blood sugar as long as there is no increased risk of internal bleeding, the guidelines of the Journal of the American College of Cardiology say.
European guidelines recommend the use of anti-coagulation treatments such as aspirin of all ages.
"Clinicians should be very selective in prescribing aspirin to people without known cardiovascular disease," said John Hopkins Cardiologist Dr. Roger Blumenthal, who led the new guidelines, in a statement. & # 39; Optimizing lifestyle habits and controlling blood pressure and cholesterol is much more important as opposed to recommending aspirin. & # 39;
"For the most part, we are now much better at treating risk factors such as hypertension, diabetes and especially high cholesterol," said the North Carolina cardiologist. Kevin Campbell to CNN. & # 39; This makes the biggest difference and probably negates any previously perceived aspirin benefit in primary prevention. & # 39;
The guidelines were compiled by the American College of Cardiology and the American Heart Association.
Campbell says he would "advocate a healthy lifestyle, smoking cessation, and risk factor change before even considering aspirin treatment in a patient without known cardiovascular disease."
However, aspirin can be life-saving for anyone who has had strokes, heart attacks, open heart surgery or stents inserted to open clogged arteries. "Ultimately, we need to individualize treatment for each patient based on their individual situation," Campbell said.
In some recent studies, which have been the greatest and longest to test the bloodstains a day, it is blood thinners in people who do not yet have heart disease or a blood vessel related problem.
It was found that aspirin did not prevent the first stroke or heart attack in people at moderate risk for one because they had more health risks such as smoking, high blood pressure or high cholesterol.
Another tested aspirin in people with diabetes who are more likely to develop or die from heart problems and found that the modest benefit it gave was outweighed by a greater risk of severe bleeding.
American doctors have long advised adults who have not had heart attacks or strokes, but are at high risk of these events taking a daily aspirin, an approach called primary prevention.
Although there is clear evidence that aspirin works for this purpose, many doctors and patients have been reluctant to follow the recommendations due to the risk of rare but potentially fatal internal bleeding.
In one study, people who took daily aspirin had a 0.38 percent lower absolute risk of heart attack, stroke or cardiovascular deaths than those who did not take this medicine.
However, aspirin was also associated with a 0.47 percent higher absolute risk of severe internal bleeding.
Aspirin did not help prevent cancer as it was hoped for.
And fish oil supplements, which are also tested in the study of people with diabetes, failed to help.
"The results show that there are cardiovascular benefits but that they are quite closely matched by increased risks of severe bleeding," says lead study author Dr. Sean Zheng from King's College London and Imperial College London.
"There has been a lot of uncertainty among doctors around the world prescribing aspirin" beyond those it is now recommended for, a study director, Dr. Jane Armitage from Oxford University. "If you're healthy, it's probably not worth it."