Clarifying the Advice on Daily Aspirin Therapy

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The American College of Cardiology and the American Heart Association no longer recommend daily low-dose aspirin therapy for the primary prevention of cardiovascular disease (CVD). However, these groups still recommend a daily aspirin to people who already have had a heart attack or stroke, who have undergone bypass surgery, or who have had a stent inserted in their coronary arteries.

For decades, aspirin therapy (typically 81 mg a day) was considered an easy way to help prevent heart attacks and other cardiovascular events-a practice now believed likely to cause more harm than good in people with no history of CVD. The new recommendation is based on the results of three studies published last year, which indicated that the benefits of once-a-day aspirin are sometimes offset by higher risks for gastrointestinal bleeding, hemorrhagic stroke (bleeding in the brain), and stomach ulcers in people with low to moderate CVD risk. The risk of bleeding rises with age, while the benefit of preventing disease may go down.

If you’re currently taking a daily aspirin to prevent CVD, don’t stop taking it without first consulting your doctor. At least one study suggests that suddenly stopping could put you at increased risk for a heart attack or stroke. What’s more, if you have a high CVD risk-and a low risk of bleeding-low-dose aspirin may still be recommended. And the U.S. Preventive Services Task Force, the federal panel of medical experts that evaluates evidence for prevention, recommends aspirin therapy in an 81-mg dose as primary prevention to people in their 50s who are at high cardiovascular risk, but not at bleeding risk, and people in their 60s but with extra caution. The task force makes norecommendations for people 70 and older due to a lack of evidence.

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