While you may have heard that taking a low-dose aspirin everyday can reduce your risk of heart attack and stroke, new research indicates this may not be true. According to guidelines that were recently released by the American College of Cardiology and the American Heart Association, taking a preventative dose is no longer recommended unless you’re at a high risk of heart attack or stroke.
“For the most part, we are now much better at treating risk factors such as hypertension, diabetes and especially high cholesterol. This makes the biggest difference, probably negating any previously perceived aspirin benefit in primary prevention,” said Dr. Kevin Campbell, a North Carolina cardiologist.
The only patients who’ll be considered candidates for taking a daily aspirin are older, high-risk patients who don’t have an increased risk for bleeding and who have trouble decreasing their cholesterol or managing their blood sugars. Other guidelines, like those in Europe, don’t recommend the use of any anti-clotting medications for extended use for anyone.
“Clinicians should be very selective in prescribing aspirin for people without known cardiovascular disease. It’s much more important to optimize lifestyle habits and control blood pressure and cholesterol as opposed to recommending aspirin,” said Dr. Roger Blumenthal, a cardiologist from John Hopkins.
Campbell calls using aspirin while young “a class 2b recommendation, meaning that it is not necessarily the best course of action; there is much debate among experts, and the data is not definitive.”
He also states he “would advocate a healthy lifestyle, smoking cessation and risk-factor modification before even considering aspirin therapy in a patient without known cardiovascular disease.”
While it’s not recommended for everyone, it can be highly helpful for those who’ve had a stroke, heart attack, open-heart surgery or stents inserted to open clogged arteries.
“Ultimately, we must individualize treatment for each patient, based on their individual situation,” Campbell said.
Why the New Guidelines?
There have been three recent studies that indicate taking aspirin can increase the risk of bleeding and death.
“Aspirin should be limited to people at the highest risk of cardiovascular disease and a very low risk of bleeding,” Blumenthal said.
If you’ll a candidate to use aspirin, it’s important to work with your doctor to understand whether or not you have a risk of internal bleeding. The risk of bleeding increases as someone ages, or if they develop kidney disease, heart disease, diabetes, or high blood pressure. Some medications — nonsteroidal anti-inflammatory drugs, steroids, and blood thinners — can also increase the risk.
Statins and lifestyle changes — like a heart-healthy diet, exercise, weight loss, and stopping smoking — should be used before aspirin.
Aspirin and Type 2 Diabetes
A major risk factor for cardiovascular disease is Type 2 diabetes. To combat the disease, guidelines recommend diet, exercise, and a weight control plan. If you have Type 2 diabetes, you should participate in 150 minutes of moderate-intensity exercise a week. You should also spend 75 minutes a week doing high intensity workouts.
Metformin should be the first medicine considered for Type 2 diabetes. SGLT-2 inhibitors and GLP-1R agonists have also shown to be effective. New studies have shown these diabetes medications to reduce the risk of heart attack and stroke.