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Advice officially shifts on low-dose aspirin for heart health

According to updated guidance, the risks of daily aspirin outweigh the benefits for most older adults — but there are exceptions.
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WASHINGTON — Older adults without heart disease shouldn't take daily low-dose aspirin to prevent a first heart attack or stroke, an influential health guidelines group said in finalized advice released Tuesday.

Bleeding risks for adults in their 60s and up who haven't had a heart attack or stroke outweigh any potential benefits from aspirin, the U.S. Preventive Services Task Force said in its updated guidance.

The panel also changed its recommendations for adults between the ages of 40 to 59, saying that people within this age group who have 10% or greater 10-year cardiovascular disease (CVD) risk should make a personal decision with their doctor, adding that the net benefit of aspirin use in this group is small. 

The recommendations are meant for people with high blood pressure, high cholesterol, obesity or other conditions that increase their chances for a heart attack or stroke. Regardless of age, adults should talk with their doctors about stopping or starting aspirin to make sure it’s the right choice for them, said task force member Dr. John Wong, a primary-care expert at Tufts Medical Center.

“Aspirin use can cause serious harms, and risk increases with age,’’ he said.

The advice for older adults backtracks on recommendations the panel issued in 2016 for helping prevent a first heart attack and stroke, but it would be in line with more recent guidelines from other medical groups.

Doctors have long recommended daily low-dose aspirin for many patients who already have had a heart attack or stroke. The task force guidance does not change that advice, but patients on aspirin should consult their primary healthcare provider to review the new guidance. 

The independent panel of disease-prevention experts analyzes medical research and literature and issues periodic advice on measures to help keep Americans healthy. Newer studies and a re-analysis of older research prompted the updated advice, Wong said.

Aspirin is best known as a pain reliever but it is also a blood thinner that can reduce chances for blood clots. But aspirin also has risks, even at low doses — mainly bleeding in the digestive tract or ulcers, both of which can be life-threatening.

Diego Mendoza contributed to this report.

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