Guidelines: No More Low Dose Aspirin for Older Adults at Low Risk

Millions of aging Americans worried about heart attacks and strokes have for years popped a low-dose aspirin each day, thinking the blood thinner might lower their risk.

But new guidelines issued Sunday by two cardiology groups say that, for most adults, the practice may no longer be warranted.

The new heart health guidelines were issued jointly by the American College of Cardiology (ACC) and the American Heart Association (AHA).

The two groups agree that for older adults at low risk — no history of heart attack, stroke or cardiac surgeries — the risk of bleeding that comes with daily low-dose aspirin is now thought to outweigh any heart benefit.

“Clinicians should be very selective in prescribing aspirin for people without known cardiovascular disease,” Dr. Roger Blumenthal, co-chair of the 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease, said in a statement.

“It’s much more important to optimize lifestyle habits and control blood pressure and cholesterol as opposed to recommending aspirin,” said Blumenthal. He’s a professor of cardiology at Johns Hopkins Medicine in Baltimore.

The bottom line, according to Blumenthal: “Aspirin should be limited to people at the highest risk of cardiovascular disease and a very low risk of bleeding.”

Why the change?

The AHA and ACC say that the most up-to-date research shows that even at a low dose (typically 81 milligrams), the odds for dangerous bleeding that comes with daily aspirin use now outweighs any benefit.

Dr. Kevin Campbell is a cardiologist working in North Carolina. Speaking with CNN, he said that advances in cardiovascular care may have also rendered daily aspirin an obsolete treatment for the average person.

“For the most part, we are now much better at treating risk factors such as hypertension, diabetes and especially high cholesterol,” explained Campbell, who wasn’t involved in drawing up the new guidelines.

“This makes the biggest difference,” he said, “probably negating any previously perceived aspirin benefit in primary prevention.”

The AHA and ACC stressed that daily aspirin does have an important role to play for people at high risk — those with a prior history of heart attack, stroke or cardiac procedures such as stenting or open heart surgery.

In those cases, daily use of the blood-thinning pill “can be lifesaving,” the groups said.

People who find they have trouble lowering their high cholesterol or controlling their blood sugar might also be considered for daily low-dose aspirin, as long as their risk for bleeding doesn’t outweigh any potential benefit, the guidelines say.

But for people at low to average risk of heart disease, a healthy lifestyle is by far the best path to living a long, healthy life.

“The most important way to prevent cardiovascular disease, whether it’s a build-up of plaque in the arteries, heart attack, stroke, heart failure or issues with how the heart contracts and pumps blood to the rest of the body, is by adopting heart healthy habits and to do so over one’s lifetime,” Blumenthal said.

That includes staying away from smoking, secondhand smoke and vaping, the two heart groups said.

It also means sticking to heart-healthy diets that focus on fruits, vegetables, nuts, whole grains and fish. Intake of salt, saturated fats, fried foods, processed meats and sugary beverages should all be kept to a minimum.

Exercise is also of great benefit to the heart: At least 150 minutes per week of moderate-intensity exercise (brisk walking, swimming, dancing or biking, for example) is recommended.

According to the new guidelines, all of the steps listed above can help you stick to another recommended goal: maintaining a healthy weight.

And what about cholesterol? Healthy living helps keep arteries clear, the AHA and ACC said, but if more help is needed, statins might have to be taken.

“Statins should be commonly recommended with lifestyle changes to prevent cardiovascular disease among people with elevated low density lipoprotein [LDL] cholesterol levels at or above 190 mg/dl,” the two groups explained in the statement.

Statins may also be indicated for people with “type 2 diabetes and anyone who is deemed to have a high likelihood of having a stroke or heart attack upon reviewing their medical history and risk factors,” the AHA and ACC said.

The new guidelines were presented on Sunday at the ACC’s annual meeting in New Orleans.

More information

There’s more about heart attack prevention at the American Heart Association.

SOURCES: American Heart Association and American College of Cardiology joint news release, March 17, 2019; CNN

Last Updated: Mar 18, 2019

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