New Guidelines Issued for Taking Low-Dose Aspirin

Two weeks ago, a commonly followed medical prevention strategy goes by the wayside.  The American College of Cardiology (ACC) and American Heart Association (AHA) primary recently released its prevention guideline announcing that it no longer recommended that low-dose aspirin be used to help prevent heart attacks and stroke in people without known cardiovascular disease. The guideline authors cite recent research suggesting the bleeding risks associated with aspirin may outweigh the benefits.

 The new guideline, released on Sunday, March 17, during ACC.19, the 68^th Annual Scientific Session and Expo, held in New Orleans, LA, emphasizes the need to identify and tackle personal or social barriers (including income and education levels, cost concerns, lack of health insurance, access to healthy foods or safe places to exercise, life stressors) as part of overall prevention strategy, and it sets a new tone for aspirin use, saying it should rarely be used.

 “The most important way to prevent cardiovascular disease … is by adopting heart healthy habits and to do so over one’s lifetime,” said Roger S. Blumenthal, MD, FACC, co-chair of the 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease, in a statement announcing the newly released guideline. “More than 80 percent of all cardiovascular events are preventable through lifestyle changes, yet we often fall short in terms of implementing these strategies and controlling other risk factors,” said Blumenthal.

 Rethinking How to Prevent Cardiovascular Disease

 The ACC/AHA guideline combines existing recommendations and new research findings, expert consensus documents, and clinical practice guidelines into one single source of guidance on the primary prevention of ASCVD. It emphasizes the importance of having a healthy lifestyle and risk assessment, both now being considered the cornerstone of preventing cardiovascular disease.  But it goes one step further by providing practical advice based on the latest research findings and proven interventions for improving diet and exercise, tobacco cessation and optimally controlling other risk factors like obesity, diabetes, high cholesterol and high blood pressure.

According to the ACC/AHA guidelines, some of the key lifestyle recommendations include engaging in regular exercise (at least 150 minutes of moderate-intensity activity each week); maintaining a healthy weight; avoiding tobacco us (including vaping or second-hand smoke); and eating healthier meals by choosing more vegetables, fruits, legumes, nuts, whole grains, and fish, while limiting trans fats, added sugars, red meats, sodium and saturated fats.

Recommendations related to team-based care, shared decision-making, and assessment of social determinants of health are also included in the new guidelines. “Social determinants of ASCVD risk – and their impact on the patient’s ability to prevent or treat risk factors – must be taken into account,” the authors said, noting that “Clinicians need to consider patients’ health literacy and education levels and assess patients’ motivation to improve their lifestyle habits.”

“Clinicians should be very selective in prescribing aspirin for people without known cardiovascular disease,” said Blumenthal said. “It’s much more important to optimize lifestyle habits and control blood pressure and cholesterol as opposed to recommending aspirin. Aspirin should be limited to people at the highest risk of cardiovascular disease and a very low risk of bleeding,” he says.

Take a Look at Lifestyle Goals

 Additionally, based on a simplified synopsis of the latest ACC/AHA Cholesterol Guideline, the new ACA/AHA guideline suggests statins be recommended with lifestyle changes to prevent cardiovascular disease among people with elevated low density lipoprotein cholesterol levels (≥ 190 mg/dl), type 2 diabetes, and anyone who is deemed to have a high likelihood of having a stroke or heart attack upon reviewing their medical history and risk factors and having a detailed discussion with their clinician.

However, the authors note: “Even if a blood pressure–reducing medication, lipid-lowering medication, or diabetes medication is ultimately prescribed, lifestyle goals should be emphasized on a regular basis. Only when a person’s risk is sufficiently high should medications to reduce ASCVD risk be considered as part of a shared decision-making process for optimal treatment,” they say.

 The 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease was simultaneously published in the Journal of the American College of Cardiology and Circulation.

Visit the Primary Prevention of Cardiovascular Disease Guideline Hub on ACC.org for clinician and patient resources. The JACC Prevention Guideline Hub also has tools including the central illustration.