New Guidance on Baby Aspirin for Adults

Taking a baby aspirin for prevention of heart disease has been suggested for years until just recently. Baby aspirin is affordable and accessible, but is it still advised?The task force known as the US Preventive Services is weighing in on changes to its recommendation for adults to take aspirin daily to prevent heart disease and stroke. A draft statement was recently published that advised adults aged 40 to 59 without a history of cardiovascular disease -- but at higher risk for said disease -- to discuss taking daily aspirin with their health care provider.The task force had previously not advised adults in their 40s to talk to their clinicians about aspirin use for heart health, assuming that it was simply safe to start. Current evidence advises AGAINST adults aged 60 and older to start taking aspirin to ward off heart disease and stroke due to possible harmful side effects, including bleeding in the stomach, intestines, and brain. The risk of bleeding rises with age.If a person in their 60s or older is already taking aspirin to prevent heart trouble, they should keep taking it... unless that person's clinician advises against it.Heart disease kills 1 out of every 4 people and is the leading cause of death in the US. A daily dose of baby aspirin has been found to reduce the risk of a heart attack or stroke in some people, but now it is not advised for everyone."Daily aspirin use may help prevent heart attacks and strokes in some people, but it can also cause potentially serious harms, such as internal bleeding," Task Force member Dr. John Wong said in a statement. "It's important that people who are 40 to 59 years old and don't have a history of heart disease have a conversation with their clinicians to decide together if starting to take aspirin is right for them."In 2016, the task force suggested that the decision to begin daily low-dose aspirin should be individual for adults aged 60 to 69. Back then, a daily low-dose aspirin in adults aged 50 to 59 with a 10% or higher risk of cardiovascular disease and no increased risk of bleeding was suggested.Low-dose aspirin has also been suggested in the prevention of colorectal cancer, but the task force believes more research is needed in this area. The new draft recommendation updates the task force's 2016 final recommendation on aspirin use to prevent cardiovascular disease and colorectal cancer -- but the new draft focuses only on the prevention of cardiovascular disease and calls for more research around taking aspirin to prevent colorectal cancer.Risk of daily aspirin use has been cited by the American College of Cardiology as well as the American Heart Association. A handful of studies published in the New England Journal of Medicine also suggest serious side effects from regular low dose aspirin usage.How can your clients reduce the risk of heart disease and stroke with or without aspirin? Here are some ideas:

1.  Control blood pressure. Adopt a DASH diet that’s low in sodium, saturated fat, added sugars, and alcohol.
2.  Eat a plant-forward diet. Include leafy green vegetables regularly, along with berries, whole fruit, and cooked dried beans.
3.  Add more soluble fiber to your diet with rolled oats, beans, fruit, or barley.
4.  Reduce sugar and alcohol. Too much of either may raise risk of heart disease and stroke. 
5.  Keep moving. Don’t just start exercising -- stay exercising. Regular physical activity helps control blood pressure, reduce cholesterol, manage weight, and improve sleep.
6.  Reduce stress. Do yoga, meditate, journal, or talk to a counselor or therapist.
7.  Go to sleep. Consistent sleep hygiene helps manage blood pressure, blood sugar, cholesterol, and overall health.
8.  Trust your healthcare provider. Ask questions. Get regular check ups and keep tabs on risk factors.

By Lisa Andrews, MEd, RD, LDReferences:

1. Home page | United States Preventive Services Taskforce (uspreventiveservicestaskforce.org)
2. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines - ScienceDirect
3. Effect of Aspirin on Disability-free Survival in the Healthy Elderly | NEJM
4. Effect of Aspirin on Cardiovascular Events and Bleeding in the Healthy Elderly | NEJM
5. Effect of Aspirin on All-Cause Mortality in the Healthy Elderly | NEJM