Over four months ago, the American College of Cardiology (ACC) and American Heart Association (AHA) released new prevention guideline announcing that they can no longer recommend that low-dose aspirin be used to help prevent heart attacks and stroke in people without known cardiovascular vascular disease (CVD).
Following on the release of the new guidelines, a research study published in the July 22 issue of the Annals of Internal Medicine, researchers at Boston-based Beth Israel Deaconess Medical Center (BIDMC), a patient care, teaching and research affiliate of Harvard Medical School, took a look at Americans 40 years old and over who use aspirin mainly to prevent cardiovascular disease.
Although before the ACC and AHA guidelines recommending aspirin only in persons without elevated bleeding risk, the revised 2019 guidelines now clearly recommend against aspirin use for seniors age 70 and over who do not have existing heart disease or stroke,” says Senior author Christina c. Wee, M.D., MPH, a general internist and researcher at BIDMC and associate professor of Medicine at Harvard Medical School. “Our findings suggest that a substantial portion of adults may be taking aspirin with their physician’s advice and potentially without their knowledge,” they ad.
According to the BIDMC researchers, aspirin use is widespread among older adults and those with peptic ulcers, painful sores in the lining of the stomach that are prone to bleeding that affect about one in 10 people.
Many Taking Aspirin Without Physician Recommendations
The research study used data gleaned from the 2017 National Health Interview Survey (NHIS), a nationally representative survey of U.S. households conducted before the release of ACC and AHA’s new guidelines, the BIDMC researchers characterized aspirin use for primarily prevent CVD. The research team found that about 25 percent of adults age 40 and over without CVD (approximately 29 million people) reported taking daily aspirin for preventing heart disease. About 6.6 million of these individuals did so without a physician’s recommendation.
The study’s findings indicated that nearly half of seniors, age 70 years and over with a history of heart disease or stroke, said that they took aspirin daily. The study’s authors noted that a history of peptic ulcer disease, another contraindication for the routine use of aspirin, was not significantly associated with lower aspirin use as one would have expected.
Balancing Medical Benefits and Harm
“Our findings show a tremendous need for health care practitioners to ask their patients about ongoing aspirin use and to advise them about the importance of balancing the benefits and harms, especially among older adults and those with prior peptic ulcer disease,” says lead author Colin O’Brien, M.D., a senior internal medicine resident of BIDMC and fellow at Harvard Medical School.
Adds, co-author Stephen Juraschek, M.D., Ph.D., a primary care physician at BIDMC, cautions that “these findings are applicable to adults who do not have a history of cardiovascular disease or stroke. If you are currently taking aspirin, discuss it with your doctor to see if it still needed for you.”
The BIDMC research study was supported by a grant from the National Heart, Lung and Blood Institute of the National Institutes of Health.